Synchronous Rectal and Hepatic Resection of Rectal Metastatic Disease

  • Sarah York Boostrom
  • Liana Tsikitis Vassiliki
  • David M. Nagorney
  • Bruce G. Wolff
  • Heidi K. Chua
  • Scott Harmsen
  • David W. Larson
Original Article

Abstract

Background

The objectives were to determine the feasibility of combined rectal and hepatic resections and analyze the disease-free survival and overall survival.

Study Design

Sixty patients who underwent resection for metastatic rectal disease from 1991 to 2005 at Mayo Clinic were reviewed. Inclusion criteria were: rectal cancer with metastatic liver disease and resectability of metastases. The exclusion criteria were: metachronous resection (n = 15). Kaplan–Meier Survival estimated overall survival (OS) and disease-free survival (DFS). Cox proportional hazard models examined the association between groups and survival.

Results

The cohort comprised 22 men and 23 women, with median age of 63 years. Surgical management included: abdominoperineal resection, 13 patients (29%); low anterior resection, 29 (64%); local excision, one; total proctocolectomy, one; and pelvic exenteration, one. Major hepatic resection was performed in 22%. There was no mortality, but there were 26 postoperative complications. Disease-free survival from local recurrence at 1, 2, and 5 years was 92%, 86%, and 80%, respectively. Disease-free survival from distant recurrence at 1, 2, and 5 years was 62%, 43%, and 28%, respectively. Overall survival at 1, 2 and 5 years was 88%, 72%, and 32%, respectively.

Conclusions

Combined rectal and hepatic resection is safe. Morbidity and mortality do not preclude concurrent resection. The DFS and OS are comparable to that of patients undergoing a staged procedure.

Keywords

Rectal Hepatic Metastatic Synchronous 

References

  1. 1.
    Ries L, Harkins D, Krapcho M, Mariotto A, Miller B, Feuer E, et al. SEER Cancer Statistics Review, 1975–2003. Bethesda, MD: National Cancer Institute2006 Contract No.: http://seer.cancer.gov/csr/1975_2003/.
  2. 2.
    Adson MA, van Heerden JA, Adson MH, Wagner JS, Ilstrup DM. Resection of hepatic metastases from colorectal cancer. Arch Surg. 1984 Jun;119(6):647–51.PubMedGoogle Scholar
  3. 3.
    Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Annals of surgery. 2002 Jun;235(6):759–66.PubMedCrossRefGoogle Scholar
  4. 4.
    Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, et al. Liver resection for colorectal metastases. J Clin Oncol. 1997 Mar;15(3):938–46.PubMedGoogle Scholar
  5. 5.
    Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg. 2007 Aug;11(8):1057–77.PubMedCrossRefGoogle Scholar
  6. 6.
    Scheele J, Altendorf-Hofmann A, Grube T, Hohenberger W, Stangl R, Schmidt K. [Resection of colorectal liver metastases. What prognostic factors determine patient selection?]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 2001 May;72(5):547–60PubMedGoogle Scholar
  7. 7.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Annals of surgery. 1999 Sep;230(3):309–18; discussion 18–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Terminology Committee of the International Hepato-Pancreato-Biliary Association. IHPBA Brisbane 2000 Terminology of Liver Anatomy & Resections. HPB (Oxford). 2000;2(3):333–9.Google Scholar
  9. 9.
    Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992 May;111(5):518–26.PubMedGoogle Scholar
  10. 10.
    Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Annals of surgery.[Review]. 2010 May; 251(5):807–18.PubMedCrossRefGoogle Scholar
  11. 11.
    Tsikitis VL, Larson DW, Poola VP, Nelson H, Wolff BG, Pemberton JH, et al. Postoperative morbidity with diversion after low anterior resection in the era of neoadjuvant therapy: a single institution experience. Journal of the American College of Surgeons. 2009 Jul;209(1):114–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Martin R, Paty P, Fong Y, Grace A, Cohen A, DeMatteo R, et al. Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. Journal of the American College of Surgeons. 2003 Aug;197(2):233–41; discussion 41–2.PubMedCrossRefGoogle Scholar
  13. 13.
    Chua HK, Sondenaa K, Tsiotos GG, Larson DR, Wolff BG, Nagorney DM. Concurrent vs. staged colectomy and hepatectomy for primary colorectal cancer with synchronous hepatic metastases. Dis Colon Rectum. 2004 Aug;47(8):1310–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Capussotti L, Ferrero A, Vigano L, Ribero D, Lo Tesoriere R, Polastri R. Major liver resections synchronous with colorectal surgery. Annals of surgical oncology. 2007 Jan;14(1):195–201.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Sarah York Boostrom
    • 1
  • Liana Tsikitis Vassiliki
    • 3
  • David M. Nagorney
    • 1
  • Bruce G. Wolff
    • 3
  • Heidi K. Chua
    • 3
  • Scott Harmsen
    • 2
  • David W. Larson
    • 3
  1. 1.Division of Gastroenterologic SurgeryMayo ClinicRochesterUSA
  2. 2.Division of BiostatisticsMayo ClinicRochesterUSA
  3. 3.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA

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