Techniques in Coloproctology

, Volume 17, Issue 1, pp 1–12 | Cite as

The management of rectal cancer with synchronous liver metastases: a modern surgical dilemma

  • A. A. P. Slesser
  • A. Bhangu
  • G. Brown
  • S. Mudan
  • P. P. TekkisEmail author



One in ten patients with rectal cancer presents with synchronous colorectal liver metastases. We present an up-to-date review of the different surgical strategies available for rectal cancer patients with synchronous colorectal liver metastases.


A literature review of MEDLINE, Cochrane and Google scholar was performed.


Twenty retrospective studies comparing staged versus simultaneous resections were found. Overall survival was similar for both approaches whilst the length of stay was decreased in simultaneous resections. Only two studies comparing the ‘reverse’ versus staged or simultaneous resections were found. The studies investigating resection versus non-resection for rectal primaries with unresectable liver metastases were limited.


Simultaneous resections are a reasonable alternative to staged resections for either advanced rectal cancers with limited liver disease or early rectal cancers with extensive liver disease. Currently, staged resections are favoured over simultaneous resections in patients with locally advanced rectal cancers with extensive liver disease. There are too few studies to determine the safety of reverse resections in the context of locally advanced rectal cancers. A resection of the primary tumour or a non-surgical intervention can be justified in the management of the rectal cancer primary in the presence of unresectable liver metastases.


Rectal cancer Surgery Synchronous liver metastases Colorectal Hepatobiliary 


Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • A. A. P. Slesser
    • 1
    • 2
  • A. Bhangu
    • 1
    • 2
  • G. Brown
    • 3
  • S. Mudan
    • 4
  • P. P. Tekkis
    • 1
    • 2
    Email author
  1. 1.Department of Colorectal SurgeryThe Royal Marsden HospitalLondonUK
  2. 2.Division of SurgeryImperial CollegeLondonUK
  3. 3.Department of RadiologyThe Royal Marsden HospitalLondonUK
  4. 4.Department of Hepatobiliary SurgeryThe Royal Marsden HospitalLondonUK

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