Complete Resection of Simultaneous Hepatic and Pulmonary Metastases from Colorectal Cancer in the Era of Modern Systemic and Surgical Therapies: A Systematic Review and Meta-Analysis.
Dominik Wróbel, Patryk Rogaczewski, Patryk Dąbrowski et al.
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In 30 seconds
This systematic review and meta-analysis assessed the feasibility and outcomes of resecting simultaneous hepatic and pulmonary metastases from metastatic colorectal cancer. It included 11 studies with 507 patients who underwent complete resection. The pooled 5-year overall survival rate after metastasectomy was 53.61% (95% CI 41.44-65.79). Complete metastasectomy was associated with better overall survival than liver resection with systemic treatment of pulmonary metastases (HR 0.30; 95% CI 0.19-0.45, p<0.001). However, complete resection was achieved in 45.65% of patients initially treated with curative intent.
Key findings
- After complete metastasectomy, pooled 5-year overall survival was 53.61% (95% CI 41.44-65.79).
- Complete metastasectomy was associated with improved overall survival versus isolated liver metastasectomy plus systemic treatment of pulmonary metastases (HR 0.30; 95% CI 0.19-0.45, p<0.001).
- Complete resection was achieved in 45.65% of patients with initial curative intent; disease progression accounted for 93.18% of treatment failures.
- Isolated liver resection was associated with improved overall survival versus systemic treatment alone (HR 0.37; 95% CI 0.27-0.51, p<0.001).
Why it matters
The findings suggest that long-term survival is possible for selected patients with simultaneous liver and lung metastases who complete resection. They also highlight the difficulty of completing the planned curative-intent treatment, most often because of disease progression. These results help frame the potential benefit of surgical strategies alongside the substantial risk that progression may prevent complete resection.
What to keep in mind
The evidence comes from 11 included studies and is not described as randomised; comparisons may therefore be affected by differences in patient selection and other confounding factors.