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.