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Jean-Francois Regnard
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Ann Thorac Surg 1998;66:214-218
© 1998 The Society of Thoracic Surgeons

Original articles: general thoracic

Surgical treatment of hepatic and pulmonary metastases from colorectal cancers

Jean-Francois Regnard, MDa, Dominique Grunenwald, MDb, Lorenzo Spaggiari, MD, PhDa, Philippe Girard, MDb, Dominique Elias, MDa, Michel Ducreux, MDa, Pierre Baldeyrou, MDb, Philippe Levasseur, MDa

a Department of Thoracic Surgery, Marie Lannelongue Hospital, Paris, France
b Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France

Accepted for publication January 24, 1998.

Address reprint requests to Dr Regnard, Department of Thoracic Surgery, Marie Lannelongue Hospital, 133 ave de la Résistance, 92350, Le Plessis Robinson, Paris, France

Background. Selected patients with double hepatic and pulmonary metastases from colorectal cancer may benefit from operation.

Methods. From 1970 to 1995, 239 patients underwent operation for resection of pulmonary metastases from colorectal cancer at two French surgical centers. Among these patients, 43 (18%) had previously undergone complete resection of hepatic metastases and constitute the subject of this retrospective study.

Results. The median interval time between hepatic and pulmonary resections was 18 months. Two pneumonectomies, 5 lobectomies, 3 segmentectomies, 6 wedge resections, and 27 metastasectomies were performed. No postoperative mortality was observed. Two patients had major postoperative complications. Seven patients (16%) underwent subsequent pulmonary resection for recurrences. Twenty-one patients were still alive, 14 free of disease. The median survival from pulmonary resection was 19 months and the 5-year probability of survival was 11%. Prethoracotomy carcinoembryonic antigen blood levels and the number of pulmonary resection were found to be significant prognostic factors; the interval time between hepatic and pulmonary resection (>36 months) was borderline significant (p = 0.06).

Conclusions. Selected patients with combined hepatic and pulmonary metastases from colorectal cancer should be considered for surgical resection. Patients with normal prethoracotomy carcinoembryonic antigen levels and late metachronous pulmonary metastasis, appear to be the best surgical candidates.




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