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Rectal Outcomes After a Liver-First Treatment of Patients with Stage IV Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The treatment of patients with metastatic rectal cancer remains controversial. We developed a reverse strategy, the liver-first approach, to optimize the chance of a curative resection. The aim of this study was to assess rectal outcomes after reverse treatment of patients with metastatic rectal cancer.

Methods

From May 2000 to November 2013, a total of 34 consecutive selected patients with histology-proven adenocarcinoma of the rectum and liver metastases were prospectively entered into a dedicated computerized database. All patients were treated via our reverse strategy. Rectal and overall survival outcomes were analyzed.

Results

Most patients presented with advanced disease (median Fong clinical risk score of 3; range 2–5). One patient failed to complete the whole treatment (3 %). Rectal surgery was performed after a median of 3.9 months (range 0.4–17.8 months). A total of 73.3 % patients received preoperative radiotherapy. Perioperative mortality and morbidity rates were 0 and 27.3 % after rectal surgery. Severe complications were reported in two patients (6.1 %): one anastomotic leak and one systemic inflammatory response syndrome. The median hospital stay was 11 days (range 5–23 days). Complete local pathological response was observed in three patients (9.1 %). The median number of lymph nodes collected was 14. The R0 rate was 93.9 %. There was no positive circumferential margin. After a mean follow-up of 36 months after rectal surgery, 5-year overall survival was 52.5 %. Five patients experienced pelvic recurrence.

Conclusions

In our cohort of selected patients with stage IV rectal cancer, the reverse strategy was not only safe and effective, but also oncologically promising, with a low morbidity rate and high long-term survival.

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Acknowledgment

We thank Stéphanie Meyer, data manager, for her help in maintaining the database. Christian Toso was supported by a professorship from the Swiss National Science Foundation (PP00P3_139021).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland

    Nicolas C. Buchs MD, Frédéric Ris MD, Pietro E. Majno MD, Axel Andres MD, Pascal Gervaz MD, Philippe Morel MD, Gilles Mentha MD & Christian Toso MD

  2. Hepato-Pancreato-Biliary Center, Geneva, Switzerland

    Pietro E. Majno MD, Arnaud D. Roth MD, Sylvain Terraz MD, Laura Rubbia-Brandt MD, Philippe Morel MD, Gilles Mentha MD & Christian Toso MD

  3. Gastrointestinal Tumor Unit, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland

    Wulfran Cacheux MD & Arnaud D. Roth MD

  4. Department of Radiology, University Hospital of Geneva, Geneva, Switzerland

    Sylvain Terraz MD

  5. Department of Pathology, University Hospital of Geneva, Geneva, Switzerland

    Laura Rubbia-Brandt MD

  6. Department of Surgery, Clinic for Visceral and Transplantation Surgery, Faculty of Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland

    Nicolas C. Buchs MD

Authors
  1. Nicolas C. Buchs MD
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  2. Frédéric Ris MD
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  3. Pietro E. Majno MD
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  4. Axel Andres MD
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  5. Wulfran Cacheux MD
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  7. Arnaud D. Roth MD
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  8. Sylvain Terraz MD
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  9. Laura Rubbia-Brandt MD
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  10. Philippe Morel MD
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  11. Gilles Mentha MD
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  12. Christian Toso MD
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Corresponding author

Correspondence to Nicolas C. Buchs MD.

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Buchs, N.C., Ris, F., Majno, P.E. et al. Rectal Outcomes After a Liver-First Treatment of Patients with Stage IV Rectal Cancer. Ann Surg Oncol 22, 931–937 (2015). https://doi.org/10.1245/s10434-014-4069-8

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  • DOI: https://doi.org/10.1245/s10434-014-4069-8

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