Repeated Resection of Pulmonary and Hepatic Metastasis of Colorectal Cancer

Shigehito Yoneyama, Yoshie Une, Yoshio Ito, Yoshinobu Koike, Hirohumi Kon and Ayami Sasaki

Department of Surgery, West Sapporo National Hospital

Introduction: Recurrence after aggressive surgical resection for hepatic and pulmonary metastasis in colorectal cancer is a major clinical problem. We retrospectively studied on indications and operations for such repeated resection. Methods: We reviewed 36 cases of colorectal cancer involving hepatic and pulmonary metastasectomy at our hospital in the last 5 years: 16 involved hepatic metastasis alone, 5 pulmonary metastasis alone, and 15 combined hepatic and pulmonary metastases (six with synchronized resection). Results: The interval from resection of the primary lesion to hepatic metastasis was 2-35 months (mean: 8.5 months), and that to pulmonary metastasis 7-43 months (mean: 15.4 months). The stage of hepatic metastasis was H1 (n=27). H2 (n=4) and hepatic metastasectomy Hr0 (n=17). Hr1 (n=4). Hr2 (n=10). The stage of pulmonary metastasis was LM1 (n=12), LM2 (n=7) and pulmonary metastasectomy was wedge resection (n=16), lobectomy (n=3). The recurrence ratio after hepatic metastasectomy was 46.6% (14/30) and 9 of 14 cases underwent repeated resection. The recurrence ratio after pulmonary metastasectomy was 47.3% (9/19) and 6 of 9 cases underwent repeated resection. Cumulative survival 3 years after first hepatic and pulmonary metastasectomy was 69.7% and 44.6% at 5 years. No significant difference was seen between metastasis stage and operation type. Patients undergoing repeated resection for metastasis of the residual liver and lung showed the longest survival at 21-59 months. Conclusion: The recurrence ratio after hepatic and pulmonary metastasectomy of colorectal cancer was high at about 47%, that patients treated by aggressive resection showed a favorable prognosis of 69.3% survival at 3 years survivals, and 44.6% at 5 years. Repeated metastasectomy in metastasized colorectal cancer thus appears justifiable.

Key words
colorectal cancer, hepatic metastasis, pulmonary metastasis, repeated metastasectomy, aggressive surgical resection

Reprint requests
Shigehito Yoneyama Department of Surgery, West Sapporo National Hospital
5-7-1 Yamanote, Nishi-ku, Sapporo, 063-0005 JAPAN

Accepted
September 28, 2005

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