Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

• Published in: Colorectal disease Vol. 19; no. 8; pp. 731 - 738
• Main Authors: Labori, K. J., Guren, M. G., Brudvik, K. W., Røsok, B. I., Waage, A., Nesbakken, A., Larsen, S., Dueland, S., Edwin, B., Bjørnbeth, B. A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-08-2017
• Subjects: Adult; Aged; Algorithms; Cancer; Chemoradiotherapy - methods; Chemoradiotherapy - mortality; Chemotherapy; Colorectal cancer; Combined Modality Therapy; Complications; Disease-Free Survival; Female; Hepatectomy - methods; Hepatectomy - mortality; Humans; Liver; Liver - surgery; Liver cancer; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver Neoplasms - therapy; liver‐first approach; Locally advanced rectal cancer; Lungs; Male; Metastases; Metastasis; Middle Aged; Neoadjuvant Therapy - methods; Neoadjuvant Therapy - mortality; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Radiation therapy; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Rectum; Rectum - surgery; Retrospective Studies; Surgery; Surgical outcomes; Survival; synchronus colorectal liver metastases; Treatment Outcome; Tumors; liver-first approach; synchronus colorectal liver metastases; Locally advanced rectal cancer
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.13622

Aim
There is debate as to the correct treatment algorithm sequence for patients with locally advanced rectal cancer with liver metastases. The aim of the study was to assess safety, resectability and survival after a modified ‘liver‐first’ approach.
Method
This was a retrospective study of patients undergoing preoperative radiotherapy for the primary rectal tumour, followed by liver resection and, finally, resection of the primary tumour. Short‐term surgical outcome, overall survival and recurrence‐free survival are reported.
Results
Between 2009 and 2013, 45 patients underwent liver resection after preoperative radiotherapy. Thirty‐four patients (76%) received neoadjuvant chemotherapy, 24 (53%) concomitant chemotherapy during radiotherapy and 17 (43%) adjuvant chemotherapy. The median time interval from the last fraction of radiotherapy to liver resection and rectal surgery was 21 (range 7–116) and 60 (range 31–156) days, respectively. Rectal resection was performed in 42 patients but was not performed in one patient with complete response and two with progressive metastatic disease. After rectal surgery three patients did not proceed to a planned second stage liver (n = 2) or lung (n = 1) resection due to progressive disease. Clavien–Dindo ≥Grade III complications developed in 6.7% after liver resection and 19% after rectal resection. The median overall survival and recurrence‐free survival in the patients who completed the treatment sequence (n = 40) were 49.7 and 13.0 months, respectively. Twenty of the 30 patients who developed recurrence underwent further treatment with curative intent.
Conclusion
The modified liver‐first approach is safe and efficient in patients with locally advanced rectal cancer and allows initial control of both the primary tumour and the liver metastases.