Maurizio Zizzo1,2, Carla Galeone3, Luca Braglia4, Lara Ugoletti5, Alessandra Siciliani6, Dania Nachira6, Stefano Margaritora6, Claudio Pedrazzoli5, Massimiliano Paci3, Filippo Lococo3. 1. Surgical Oncology Unit, Azienda Unità Sanitaria Locale/IRCCS of Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy, zizzomaurizio@gmail.com. 2. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy, zizzomaurizio@gmail.com. 3. Thoracic Surgery Unit, Azienda Unità Sanitaria Locale/IRCCS of Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 4. Infrastructure Research and Statistics, Azienda Unità Sanitaria Locale/IRCCS of Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 5. Surgical Oncology Unit, Azienda Unità Sanitaria Locale/IRCCS of Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. 6. Thoracic Surgery Unit, Università Cattolica del Sacro Cuore-Policlinico "A. Gemelli", Roma, Italy.
Abstract
BACKGROUND/AIMS: At present, benefits of surgical resection and appropriate selection criteria in patients affected by both hepatic and pulmonary metastases of colorectal cancer (CRC) are under discussion. Our analysis focused on a surgical series of such patients and our final aim consisted in identifying potential prognostic factors. METHODS: Eighty-five patients undergoing resection of both hepatic and pulmonary metastases at 2 Healthcare Institutions from January 1993 to June 2015 were retrospectively reviewed as concerned clinical information, surgical notes and pathological features. Patient, treatment, and outcome variables were analyzed by use of log-rank tests, Cox regression, and Kaplan-Meier methods. RESULTS: Liver turned out as the first site of metastasis in 75% patients, lung in 13% patients, and both sites in 12% patients. Multiple hepatic metastases were detected in 67% patients and pulmonary metastases in 31% patients. Two hundred eighteen surgical interventions were performed (mean 2.56 for each patient). Overall survival (OS) rates at 3-, 5-, and 10-year follow-up from colorectal resection were 94, 79, and 38% respectively. Median OS was 8.31 years. Survival turned out significantly longer for patients with disease-free interval (DFI) exceeding 1 year between first metastasectomy and diagnosis of second metastases and in patients affected by metachronous pulmonary metastases. CONCLUSIONS: Surgical resection of both hepatic and pulmonary metastases of CRC represents a safe and effective treatment. It might lead to rewarding long-term survival rates in high selected patients. Shorter DFIs between first metastasectomy and diagnosis of second metastases can determine worse prognoses. In addition, poor outcomes could be predicted also for patients affected by synchronously detected pulmonary CRC metastases, although further confirmatory analyses are strongly required.
BACKGROUND/AIMS: At present, benefits of surgical resection and appropriate selection criteria in patients affected by both hepatic and pulmonary metastases of colorectal cancer (CRC) are under discussion. Our analysis focused on a surgical series of such patients and our final aim consisted in identifying potential prognostic factors. METHODS: Eighty-five patients undergoing resection of both hepatic and pulmonary metastases at 2 Healthcare Institutions from January 1993 to June 2015 were retrospectively reviewed as concerned clinical information, surgical notes and pathological features. Patient, treatment, and outcome variables were analyzed by use of log-rank tests, Cox regression, and Kaplan-Meier methods. RESULTS: Liver turned out as the first site of metastasis in 75% patients, lung in 13% patients, and both sites in 12% patients. Multiple hepatic metastases were detected in 67% patients and pulmonary metastases in 31% patients. Two hundred eighteen surgical interventions were performed (mean 2.56 for each patient). Overall survival (OS) rates at 3-, 5-, and 10-year follow-up from colorectal resection were 94, 79, and 38% respectively. Median OS was 8.31 years. Survival turned out significantly longer for patients with disease-free interval (DFI) exceeding 1 year between first metastasectomy and diagnosis of second metastases and in patients affected by metachronous pulmonary metastases. CONCLUSIONS: Surgical resection of both hepatic and pulmonary metastases of CRC represents a safe and effective treatment. It might lead to rewarding long-term survival rates in high selected patients. Shorter DFIs between first metastasectomy and diagnosis of second metastases can determine worse prognoses. In addition, poor outcomes could be predicted also for patients affected by synchronously detected pulmonary CRC metastases, although further confirmatory analyses are strongly required.