Oncological strategies for locally advanced rectal cancer with synchronous liver metastases, interval strategy versus rectum first strategy: a comparison of short-term outcomes
The goal of treatment for patients with synchronous liver metastases (SLM) from rectal cancer is to achieve a complete resection of both tumor locations. For patients with symptomatic locally advanced rectal cancer with resectable SLM at diagnosis, our usual strategy has been the rectum first approach (RF). However, since 2014, we advocate for the interval approach (IS) that involves the administration of chemo-radiotherapy followed by the resection of the SLM in the interval of time between rectal cancer radiation and rectal surgery.
From 2010 to 2016, 16 patients were treated according to this new strategy and 19 were treated according RF strategy. Data were collected prospectively and analyzed with an intention-to-treat perspective. Complete resection rate, duration of the treatment and morbi-mortality were the main outcomes.
The complete resection rate in the IS was higher (100%, n = 16) compared to the RF (74%, n = 14, p = 0.049) and the duration of the strategy was shorter (6 vs. 9 months, respectively, p = 0.006). The incidence of severe complications after liver surgery was 14% (n = 2) in the RF and 0% in the IS (p = 1.000), and after rectal surgery was 24% (n = 4) and 12% (n = 2), respectively (p = 1.000).
The IS is a feasible and safe strategy that procures higher level of complete resection rate in a shorter period of time compared to RF strategy.
KeywordsRectal cancer Synchronous liver metastases Rectum first strategy Interval strategy
Synchronous liver metastases
Rectum first strategy
To the Dr. Trueta Hospital Cancer Registry and to the Multidisciplinary Digestive Tumor Board, for their help.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study has been approved by The Dr. Josep Trueta University Hospital's ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- 1.Zalinski S, Mariette C, Farges O. Management of patients with synchronous liver metastases of colorectal cancer. Clinical practice guidelines. Guidelines of the French society of gastrointestinal surgery (SFCD) and of the association of hepatobiliary surgery and liver transplantation (ACHBT). Short version. J Visc Surg. 2011;148(3):e171–82.CrossRefPubMedGoogle Scholar
- 12.Pang YY. The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000;2(3):333–9.Google Scholar
- 21.Garcia-Aguilar J, Smith DD, Avila K, Bergsland EK, Chu P, Krieg RM, et al. Optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann Surg. 2011;254(1):97–102.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Probst CP, Becerra AZ, Aquina CT, Tejani MA, Wexner SD, Garcia-Aguilar J, et al. Extended intervals after neoadjuvant therapy in locally advanced rectal cancer: the key to improved tumor response and potential organ preservation. J Am Coll Surg. 2015;221(2):430–40.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Labori KJ, Guren MG, Brudvik KW, Rosok BI, Waage A, Nesbakken A, et al. Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short term surgical outcomes, overall and recurrence free survivals. Colorectal Dis. 2017;19:731–8.CrossRefPubMedGoogle Scholar