Approach to Synchronous Lung and Liver Metastases and Single-Incision Combined Resection

The resection of all metastatic deposits in the liver and the lung confers a survival benefit to patients diagnosed with stage IV colon cancer. Therefore, patients with metastases to both locations may have to endure multiple surgical procedures throughout their lifetimes, first to resect the disease on initial presentation and, later, to resect new or recurrent pulmonary or liver lesions. To reduce the burden of these multiple procedures on patients’ quality of life and on the medical system, we devised a novel method to remove all liver and lung metastases during the same operation, via a transdiaphragmatic route. The advantages for patients are numerous, including a single anesthesia and surgical procedure and avoidance of the additional pain associated with a second resection. The experience with this approach over the years has proven it to be safe and cost effective. In this chapter, we present selection criteria for patients and a technical description of the safe conduct of the combined procedure.