Prediction of the prognosis and surgical indications for pulmonary metastectomy from colorectal carcinoma in patients with combined hepatic metastases.

BACKGROUND: The value of surgical treatment for patients with pulmonary and hepatic metastases from colorectal carcinoma is controversial. The purpose of this study was to analyze our initial experience with this aggressive strategy, and to define the prognosis and the surgical indications. METHODS: The records of 35 patients who underwent surgical treatments for both hepatic and pulmonary metastases from colorectal carcinoma, from January 1997 to December 2008, were retrospectively analyzed. RESULTS: There were 18 females and 17 males with a median age was 62.0 years. The primary colorectal neoplasm was located at the colon in 23 patients (65.7%) and in the rectum in 12 patients (34.3%). The overall 5-year and 10-year survival rates were 65.3% and 31.5% from the date of primary colorectal resection, respectively. For patients who underwent metachronous hepatic and pulmonary surgical treatment, the 10-year survival rate was 40.9%, which was significantly better than that of those undergoing synchronous hepatic and pulmonary surgical treatment (p=0.0265). Patients who have pulmonary less than ten of metastasis thus seemed to have a better prognosis than those with more than ten, but the difference was quite significant (p=0.0719). In a multivariate Cox proportional hazards model, synchronous hepatic and pulmonary metastases was identified as an independent predictor of adverse survival (p=0.0073). CONCLUSIONS: The results of our study suggest that hepatic and pulmonary surgical treatment can provide a better prognosis for patients with metachronous hepatic and pulmonary metastases from colorectal carcinoma. We believe that aggressive metastasectomy can be an option for selected patients, even if a patient has been previously treated for hepatic and pulmonary metastases from colorectal carcinoma.

Surgical treatment of stage IV non-small cell lung cancer.

Most stage IV non-small-cell lung cancer (NSCLC) patients are not amenable to curative treatment. The purpose of this study was to analyse our initial experience with an aggressive surgical strategy for stage IV NSCLC, and to define which patients can benefit from this treatment. Forty-six stage IV NSCLC patients who underwent surgical resection of both primary lung cancer and metastatic sites from April 1989 to December 2010 were included in this study. The record of each patient was reviewed for age, gender, pN status, sites of metastasis, histology, surgical procedure and duration of survival. There were 13 females and 33 males. Their median age was 62.0 years (range, 44-82 years). The overall 5-year survival rate was 23.3% (median, 20.0 months), and the disease-free survival rate was 15.8% at 5 years (median, 16.1 months). Patients with the pN2 status had a significantly worse survival than patients with a pN0 or pN1 status (8.6 versus 33.1%, P = 0.0497). According to a multivariate Cox proportional hazards analysis, no independent predictor of survival was identified. The results of our study suggest that surgical treatment can extend the survival in stage IV NSCLC patients if the patients can tolerate surgery.