Iterative Hepatic and Pulmonary Metastasectomy in Stage IV Colorectal Cancer: Impact on Survival and Surgical Outcomes.

Abstract

Colorectal cancer frequently metastasizes to the liver and lungs. Despite curative-intent resections, recurrence rates are high. While initial hepatic and pulmonary metastasectomies have been well-studied, data are limited on outcomes following iterative resections for recurrent metastases in both locations. We retrospectively assessed the long-term outcome (> 10 years) of 97 patients who underwent iterative hepatic and pulmonary resections for recurrent colorectal cancer metastases. Post initial hepatic metastasectomy survival rates showed no difference for synchronous and metachronous colorectal liver metastases. Multiple hepatic as well as pulmonary metastasectomies did ameliorate patient survival compared to single resections. Postoperative complications ≥ Clavien Dindo grade II after a second hepatic metastasectomy were associated with reduced overall survival, while complication profiles did not alter survival rates after pulmonal metastasectomies. Importantly, iterative liver and lung surgery did not increase subsequent postoperative complications, with median complication severity remaining at Clavien Dindo grade II-IIIa across successive resections. Our data suggest comparable benefits from hepatic metastasectomy regardless of metastatic sequence. Our findings demonstrate the safety and potential survival benefits of iterative hepatic and pulmonary resections for recurrent colorectal cancer metastases. These data support an aggressive surgical approach in selected patients with recurrent colorectal metastases.