Jocelyn Bellier1,2, Julien De Wolf3, Mohamed Hebbar4, Mehdi El Amrani5, Christophe Desauw4, Emmanuelle Leteurtre6, François-René Pruvot5, Henri Porte3, Stéphanie Truant5. 1. Department of Thoracic Surgery, Lille University Medical Center, Hôpital Albert Calmette, CHRU Lille, University of Lille Nord de France, Bld du Pr Jules Leclercq, 59037, Lille Cedex, France. jocelyn.bellier@chru-lille.fr. 2. Pôle de Chirurgie Thoracique, Hôpital Albert Calmette, CHRU Lille, Bld du Pr Jules Leclercq, 59037, Lille Cedex, France. jocelyn.bellier@chru-lille.fr. 3. Department of Thoracic Surgery, Lille University Medical Center, Hôpital Albert Calmette, CHRU Lille, University of Lille Nord de France, Bld du Pr Jules Leclercq, 59037, Lille Cedex, France. 4. Department of Medical Oncology, Lille University, Lille University Medical Center, University of Lille Nord de France, 2 Avenue Oscar Lambret, 59037, Lille Cedex, France. 5. Department of Digestive Surgery and Transplantation, Lille University Medical Center, University of Lille Nord de France, 2 Avenue Oscar Lambret, 59037, Lille Cedex, France. 6. UMR-S 1172 - JPARC - Jean-Pierre Aubert Research Center, University of Lille, Inserm, CHU Lille, 59000, Lille, France.
Abstract
BACKGROUND: Liver and lungs are the two most frequent sites of metastatic spread of colorectal cancer (CRC). Complete resection of liver and/or lung metastases is the only chance of cure, and several studies have reported an improved survival after an aggressive treatment. Nevertheless, CRC liver metastases (CLM) have been recognized as a pejorative factor for patients undergoing pulmonary metastasectomy. We report our experience with patients successively operated on for CRC hepatic and pulmonary metastasis (CPM) and seek to identify prognostic factors. METHODS: All consecutive patients who had resection of CPM and CLM between 2001 and 2014 were enrolled in the study. Clinicopathological and survival data were retrospectively analysed. RESULTS: Forty-six patients underwent resections of both CLM and CPM. Hepatic resection preceded pulmonary resection in most cases (91.3%). The median intervals between the resection of the primary tumour and the hepatic recurrence and between hepatic and pulmonary recurrences were 12 months [0-72] and 21.5 months [1-84], respectively. The mortality rate following CPM resection was 4.3%. After a median follow-up of 41.5 months [0-126], 35 patients recurred of whom 14 (40%) and 11(31.4%) could benefit from repeated resection of recurrent CLM and CPM, respectively. The median and 5-year overall survivals (OS) were 53 months and 49%, respectively. No prognostic factor was identified. CONCLUSION: An aggressive management of CLM and CPM, including repeated resections, may provide a long-term survival comparable to survival of patients with unique metastasectomy. The absence of prognostic factor may reflect the highly selected pattern of the eligible patients.
BACKGROUND: Liver and lungs are the two most frequent sites of metastatic spread of colorectal cancer (CRC). Complete resection of liver and/or lung metastases is the only chance of cure, and several studies have reported an improved survival after an aggressive treatment. Nevertheless, CRC liver metastases (CLM) have been recognized as a pejorative factor for patients undergoing pulmonary metastasectomy. We report our experience with patients successively operated on for CRC hepatic and pulmonary metastasis (CPM) and seek to identify prognostic factors. METHODS: All consecutive patients who had resection of CPM and CLM between 2001 and 2014 were enrolled in the study. Clinicopathological and survival data were retrospectively analysed. RESULTS: Forty-six patients underwent resections of both CLM and CPM. Hepatic resection preceded pulmonary resection in most cases (91.3%). The median intervals between the resection of the primary tumour and the hepatic recurrence and between hepatic and pulmonary recurrences were 12 months [0-72] and 21.5 months [1-84], respectively. The mortality rate following CPM resection was 4.3%. After a median follow-up of 41.5 months [0-126], 35 patients recurred of whom 14 (40%) and 11(31.4%) could benefit from repeated resection of recurrent CLM and CPM, respectively. The median and 5-year overall survivals (OS) were 53 months and 49%, respectively. No prognostic factor was identified. CONCLUSION: An aggressive management of CLM and CPM, including repeated resections, may provide a long-term survival comparable to survival of patients with unique metastasectomy. The absence of prognostic factor may reflect the highly selected pattern of the eligible patients.
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