Simultaneous lungs and liver resections in metastatic colorectal cancer patients

Introduction: Colorectal metastases mostly occurred in the liver and lungs. Synchronous liver and lungs metastases is identified in approximately 20% of all colorectal metastases. There are two well-known possible approaches of surgical treatment of patients with synchronous colorectal liver and lungs metastases. First includes simultaneous resection of the colorectal primary with the following resection of the liver and lungs metastases and second is a staged resection approach. However, at present, the issue of feasibility and effectiveness of simultaneous operations for primary tumor, metastatic liver and lungs lesions in patients with synchronous metastatic colorectal cancer (SMCLC) is negotiated and remains uncertain. This study aimed to compare the surgical outcomes and survival benefit between synchronous and staged resections of the colorectal liver and lungs metastases. Methods: Data of 178 patients with colorectal cancer and synchronous liver or/and lungs metastases were analyzed between 2007-2017. There were two groups of patients. 81 patients from group A were undergone synchronous liver, lungs and colon resection whereas 97 patients from group B - staged resection, respectively. There were 23 lungs resections in group A. Sixteen out of 23 were performed with thoracic approach whereas other seven resected with transabdominal transdiaphragmal approach. In group B all 38 lungs resections were done with transthoracic approach. It is worth pointing out that all 7 patients from group A with transdiaphragmatic approach had metastases localized in lower lung lobes which, in turn, were relatively easily reached. Results: Overall 3-year survival in group A with synchronous resections was 48 % and in group B - 51 % (р=0.19). There were no significant differences in overall proportion of post-operative complications in the groups A and B, 28 %(n = 44) and 32,4% (n = 48), respectively (p = 0.7). Shorter duration of the operation was observed in group A – 360.3 (±10.1) min in comparison with group B 460.1(±15.2) min (р=0.001). Patients after staged resection stayed longer in clinic - 23.3±0.8 bed-days, then those who undergone synchronous resections -10.2±0.4 bed-days (p < 0.001) admitted with shorter recovery terms in postoperative period. Conclusion: It is clearly seen that synchronous resections are effective and safe enough in comparison with staged operations in patients with SMCLC and should be considered with a meticulous selection of patients. Subsequent research is required with further investigation of prognosis factors and specific criteria for selection of patients for simultaneous or staged surgical treatment. The analysis of our research has also indicated the necessity of the development of a differentiated approach in SMCLC surgical treatment. Moreover, the assessment of the economic efficacy and life quality of patients are also needed.