Short- and Long-Term Outcomes of a Transdiaphragmatic Approach for Simultaneous Resection of Colorectal Liver and Lung Metastases

Background: Long-term outcomes for simultaneous resection of synchronous colorectal liver and lung metastases are unknown. To address this gap, we compared outcomes and costs of three strategies for such resection.

Methods: Patients who underwent resection of synchronous colorectal liver and lung metastases during 2000-2018 were grouped by surgical strategy: simultaneous resection via a transdiaphragmatic approach (transdiaphragmatic) or separate abdominal and thoracic incisions (transthoracic) and nonsimultaneous staged resection (staged). Operative and postoperative outcomes, survival, cumulative lung recurrence, and surgical costs were evaluated.

Results: The study included 63 patients, 29 with transdiaphragmatic, 14 with transthoracic, and 20 with staged resection. The groups had similar demographic and clinicopathologic characteristics. Lung resection-associated blood loss for the transdiaphragmatic group was similar to that for the transthoracic group (P = .165) but lower than that for the staged group (P = .006). Hospital stay was shorter for the simultaneous groups than for the staged group (P = .007). Median surgical costs were significantly higher in the staged group ($130,733, interquartile range [IQR] $91,109-$173,573) than in the transdiaphragmatic ($70,620, IQR $58,376-$86,203, P < .001) or transthoracic ($62,991, IQR $57,405-$98,862, P < .001) group but did not differ between the transdiaphragmatic and transthoracic groups (P = .786). Rates of postoperative complications, recurrence-free survival, overall survival, and cumulative lung recurrence were similar among the groups.

Conclusions: Simultaneous resection of synchronous colorectal liver and lung metastases via a transdiaphragmatic approach is associated with lower blood loss, lower costs, and similar survival compared with staged resection.

Keywords: Simultaneous resection; Synchronous liver and lung metastases; Transdiaphragmatic approach.