Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases * A.D. Barlow a, * , A. Nakas a , C. Pattenden b , A.E. Martin-Ucar a , A.R. Dennison b , D.P. Berry b , D.M. Lloyd c , G.S. Robertson c , D.A. Waller a a Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester, UK b Department of Hepatobiliary Surgery, Leicester General Hospital, Gwendolen Road, Leicester, UK c Department of Hepatobiliary Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, UK Accepted 12 June 2008 Available online 25 July 2008 Abstract Aims: Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy. Methods: Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data. Results: Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2e10) days for the pulmo- nary and 7 (1e23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to meta- stasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8e87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%. Conclusion: We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival. Ó 2008 Elsevier Ltd. All rights reserved. Keywords: Metastases; Liver; Lung; Resection; Colorectal Introduction Overall 40% of patients with colorectal cancer will develop hepatic metastases and 20% will develop pulmonary metastases. Following seemingly curative resection of the primary tumour, these figures fall to 10e20 and 5e10% re- spectively, but only 15% of these patients have disease limited to one site. 1 Surgical resection is widely accepted as the treatment for isolated hepatic and pulmonary metastases of colorectal origin, albeit with careful patient selection. Of those patients with hepatic metastases, it has been estimated that only 10e15% are candidates for potentially curative hepatic resection. 1 Median survival following resection of colorectal hepatic metastases has been reported between 42 and 68 months, with 5-year survival between 27 and 57%. 2,3 Indeed some studies have shown a 10-year survival of 22e23% and 20-year survival of 18%. 3,4 Studies of resection of colorectal pulmonary metastases have reported * This paper was presented in part at the BASOwACS Scientific Confer- ence, November 2006, Royal College of Surgeons, London, UK. * Corresponding author at: Department of Transplant Surgery, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK. Tel.: þ44 77 4043 3930; fax: þ44 11 6249 8183. E-mail addresses: adambarlow@doctors.net.uk (A.D. Barlow), apostolos.nakas@uhl-tr.nhs.uk (A. Nakas), clarepattenden@doctors. net.uk (C. Pattenden), lungsout@yahoo.com (A.E. Martin-Ucar), ashley. dennison@uhl-tr.nhs.uk (A.R. Dennison), david.berry@uhl-tr.nhs.uk (D.P. Berry), david.lloyd@uhl-tr.nhs.uk (D.M. Lloyd), gavin.robertson@ uhl-tr.nhs.uk (G.S. Robertson), david.waller@uhl-tr.nhs.uk (D.A. Waller). 0748-7983/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2008.06.012 Available online at www.sciencedirect.com EJSO 35 (2009) 307e312 www.ejso.com