Surgical treatment of synchronous colorectal liver and lung metastases： the usefulness of thoracophrenolaparotomy for single stage resection

When suitable, surgery still remains the therapeutic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, simultaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients（median age of 53 years） carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolaparotomy. The median number of liver metastases removed was 5（range 2-30） and of lung metastases removed was 2（range 1-3）. Lung metastases were located in the upper lobe in 1 patient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity： one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases： in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.

Telomerase activity and homozygous deletions of the p16 gene in liver metastases of colorectal carcinoma

Objective To study the interaction between telomerase activity and abnormalities of the p16 gene in liver metastases of colorectal carcinoma.Methods Telomerase activity was detected by a non-isotopic PCR-based telomeric repeat amplification protocol (TRAP) assay, and homozygous deletions of the p16 gene were detected by a semiquantitative multiplex polymerase chain reaction in tissue samples from 24 liver metastases of colorectal carcinoma and 5 primary colorectal carcinomas.Results Telomerase activity was observed in 19 (79.2%) of 24 liver metastases of colorectal carcinoma.Telomerase activity was also observed in all 5 primary colorectal carcinomas and in 3 of their liver metastatic samples. The incidence of telomerase activity in liver metastases of colorectal carcinoma was not significantly correlated to tumor diameter, number of tumors, cirrhosis, and HBsAg. Homozygous deletions of the p16 gene were found in 9 of 24 (37.5%) liver metastases of colorectal carcinoma. Homozygous deletions of the p16 gene were observed in 2 of the 5 primary colorectal carcinomas and in 1 of the matching liver metastatic cancers. There was a correlation between telomerase activity and homozygous deletions of the p16 gene.Conclusions There is a correlation between telomerase activity and homozygous deletions of the p16gene in liver metastases of colorectal carcinoma, suggesting its crucial role in liver metastases. However,telomerase activation and homozygous deletions of the p16 gene might not be the initiating event in liver metastases of colorectal carcinoma.