Surgical outcomes after resection of both hepatic and pulmonary metastases from colorectal cancer

Background: The efficacy and the indications of resection of synchronous or metachronous hepatic and pulmonary metastases from colorectal cancer (CRC) are controversial. This study retrospectively reviewed the cases of CRC patients who underwent both liver and lung resection to define the appropriate indications for surgical resection in patients with hepatic and pulmonary metastases. Methods: A total of 39 patients with both hepatic and pulmonary metastases from CRC underwent both liver and lung resection from January 1987 to December 2009. The relapse-free survival (RFS) and overall survival (OS) from the resection for the first metastasis were evaluated by a Kaplan-Meyer analysis. Prognostic factors were analyzed using the log-rank test and a Cox proportional hazards model. Results: The median RFS and the 5-year RFS rate of all patients were 12 months and 2.6 %, respectively. The median survival time (MST) and 5-year OS rate of all patients were 66 months and 48.3 %, respectively. The MST of the patients with a long (>1 year) disease-free interval (DFI) could not be calculated, but their 5-year OS rate was 73.7 %. In contrast, the MST and 5-year OS rate of the patients with a short (<1 year) DFI were 29 months and 37.5 %, respectively. The short DFI was the only prognostic factor in the multivariate analysis. Conclusions: Aggressive surgical resection of both hepatic and pulmonary metastases from CRC should be undertaken in selective patients, including those with a long DFI.