Long-Term Outcome After Resection of Hepatic and Pulmonary Metastases in Multivisceral Colorectal Cancer

Christopher Berlin; Geoffroy Andrieux; Magdalena Menzel; Gabriel J Stöger; Andreas Gengenbach; Luisa Schäfer; Hans C Hillebrecht; Rebecca Kesselring; Uyen-Thao Le; Stefan Fichtner-Feigl; Philipp A Holzner

doi:10.3390/cancers16223741

Long-Term Outcome After Resection of Hepatic and Pulmonary Metastases in Multivisceral Colorectal Cancer

Cancers (Basel). 2024 Nov 5;16(22):3741. doi: 10.3390/cancers16223741.

Authors

Affiliations

¹ Department of General and Visceral Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany.
² German Cancer Consortium (DKTK) Partner Site, 79106 Freiburg im Breisgau, Germany.
³ IMMediate Advanced Clinician Scientist-Program, University of Freiburg, 79106 Freiburg im Breisgau, Germany.
⁴ Institute of Medical Bioinformatics and Systems Medicine, Medical Center-University of Freiburg, 79106 Freiburg im Breisgau, Germany.
⁵ Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany.

Abstract

Background/objectives: Colorectal cancer (CRC) with hepatic (CRLM) and pulmonary metastases (CRLU) presents a significant clinical challenge, leading to poor prognosis. Surgical resection of these metastases remains controversial because of limited evidence supporting its long-term benefits. To evaluate the impact of surgical resection of both hepatic and pulmonary metastases on long-term survival in patients with multivisceral metastatic colorectal cancer, this retrospective cohort study included 192 patients with UICC stage IV CRC treated at a high-volume academic center.

Methods: Patients were divided into two groups: those who underwent surgical resection of both hepatic and pulmonary metastases (n = 100) and those who received non-surgical treatment (n = 92). Propensity score matching was used to adjust for baseline differences. The primary outcome was overall survival (OS).

Results: Unadjusted analysis showed a significant OS benefit in the surgical group (median OS: 6.97 years) compared with the conservative group (median OS: 2.17 years). After propensity score matching, this survival advantage persisted (median OS: 5.58 years vs. 2.35 years; HR: 0.3, 95% CI: 0.18-0.47, p < 0.0001).

Conclusions: Surgical resection of hepatic and pulmonary metastases in multivisceral metastatic CRC significantly improves long-term survival, supporting an aggressive surgical approach in selected patients.

Keywords: colorectal cancer metastasis; liver and lung metastasis; metastasis surgery; multivisceral colorectal cancer.

Grants and funding

We thank L. Mehmed and R. Paul for supplying data from the CCCF database. We acknowledge funding from the IMMediate Advanced Clinician Scientist-Program, Department of Medicine II, Medical Center–University of Freiburg and Faculty of Medicine, University of Freiburg, funded by the Bundesministerium für Bildung und Forschung (BMBF, Federal Ministry of Education and Research)—01EO2103 (C.B.). We also acknowledge funding from BMBF within the Medical Informatics Funding Scheme EkoEstMed–FKZ 01ZZ2015 (G.A.).