Patel, N, Woo, Y, Medich, D, Celebrezze, J, Maley, R, Keenan, R, Landreneau, R, and Roh, M

Patients presenting with advanced stage IV colorectal carcinoma involving both the liver and lungs provide a significant therapeutic challenge. Hepatic metastases have often been felt to preclude pulmonary metastasectomy. With the recent advances in surgical options, should patients with both liver and lung metastases be considered for surgical resection? The present study reviews the impact of such aggressive management on disease free (DFS) and overall survival (OS). The clinical course of 60 patients presenting with colorectal metastasis to the lung alone (Group I, n= 42) or combined hepatic and lung metastases (Group II, n=18) were reviewed. All patients underwent complete resection of their lung metastases. Surgical control of hepatic tumor burden was achieved by tumor ablation, intra-arterial therapy and/or resection. Patients in group II presented with liver metastases at the time of their primary diagnosis (n =5), metachronous metastasis involving both the lungs and liver (n=5) or with metachronous metastases involving the liver then lungs (n =8). All patients in group I and group II were available for a mean follow-up of 26 and 24 months respectively. Cancer specific and overall mortality during this period were 58% and 63%. Disease free survival (NED), patients alive with disease (AWD) and mortality for both groups can be found in the table 1 below. These findings demonstrate that aggressive surgical management of pulmonary metastases in the presence of liver metastases offers a similar benefit as compared to patients with pulmonary metastases alone. Therefore, hepatic metastatic disease does not preclude an attempt at pulmonary metastasectomy if the liver disease can be controlled with curative intent. Such an approach achieves comparable DFS and OS when compared to pulmonary metastasectomy alone.

	AWD	NED	Death	Recurrence
Group I	8/42 (19%)	9/42 (21%)	25/42 (59%)	26/42 (61%)
Group II	3/18 (17%)	5/18 (28%)	10/18 (56%)	4/18 (22%)
Overall	11/60 (18%)	14/60 (23%)	35/60 (58%)	30/60 (50%)

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