Complete Resection of Simultaneous Hepatic and Pulmonary Metastases from Colorectal Cancer in the Era of Modern Systemic and Surgical Therapies: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Data suggest promising outcomes with resection of simultaneous hepato-pulmonary metastases (HPM) from metastatic colorectal cancer (mCRC). However, there is no consensus regarding the effectiveness of this approach. Therefore, we aimed to evaluate the feasibility and clinical benefit of metastasectomy of simultaneous HPM from mCRC. METHODS: A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including studies from PubMed and Embase up to October 1, 2025. Outcomes were reported as proportions and as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: In total, 11 studies, encompassing 507 patients with HPM who underwent complete resection, were included. The 5-year overall survival (OS) rate after metastasectomy was 53.61% (95% CI 41.44-65.79), whereas the 3-year OS rate was 70.9% (95% CI 61.73-80.06). The 5-, 3-, and 1-year disease-free survival rates were 14.73%, 19.48%, and 55.31%, respectively. Complete resection was achieved in 45.65% of patients with initial curative intent, with disease progression accounting for 93.18% of treatment failures. Complete metastasectomy was associated with improved OS compared with isolated liver metastasectomy with systemic treatment of pulmonary metastases (HR 0.30; 95% CI 0.19-0.45, p<0.001), whereas isolated liver resection also improved OS compared with systemic treatment alone (HR 0.37; 95% CI 0.27-0.51, p<0.001). CONCLUSION: In the era of modern therapies, complete resection of HPM from mCRC is associated with a substantial survival benefit and should be considered a primary treatment goal in selected patients. However, less than half of patients with initial curative intent complete the planned treatment. Isolated liver metastasectomy may still confer a survival benefit compared with systemic treatment alone.