Combined Hepatic and Pulmonary Metastasectomies From Colorectal Carcinoma. Data From the Prospective Spanish Registry 2008–2010

Abstract

Introduction: Resection of both liver and lung metastases from colorectal carcinoma (CRC) is a standardof care in selected patients with oligometastatic disease. We present here the analysis of the subgroupof patients undergoing combined surgery from the Spanish Group of Surgery of Pulmonary Metastases(PM) from Colorectal Carcinoma (GECMP-CCR-SEPAR).Methods: We analyze characteristics, survival and prognostic factors of patients undergoing combinedresection from March-2008 to February-2010 and followed-up during at least 3 years, from the prospec-tive multicenter Spanish Registry.Results: A total of 138 patients from a whole series of 543 cases from 32 thoracic surgery units underwentboth procedures. Seventy-seven (43.8%) resected liver metastases were synchronic with colorectal tumor.Median disease specific survival (DSS) from first pulmonary metastasectomy was 48.9 months, beingthree and 5-year DSS 65.1% and 41.7%, respectively. From CRC-surgery median DSS was 97.2 months, with3 and 5-year DSS rates of 96.7% and 77%, respectively. Five-year DSS from pulmonary metastasectomywas 41.7% for patients with combined resection and 52.4% for those without hepatic involvement (P = .04).Differences disappeared when considering DSS from colorectal surgery. Carcinoembrionary antigen (CEA)before lung surgery over 10 mg/dl and bilateral PM were independent prognostic factors for survival(hazard ratio 2.4 and 2.5, respectively).Conclusions: Patients with resection of PM of CRC with history of resected hepatic metastases presentedsignificantly lower disease specific survival rates than those undergoing pulmonary metastasectomyalone. CEA before lung surgery and bilateral PM associated worse prognosis.