Top

World Journal of Surgery

Published in:

01-12-2011

Locally Advanced Mid/Low Rectal Cancer with Synchronous Liver Metastases

Authors: Luca Viganò, Mehdi Karoui, Alessandro Ferrero, Claude Tayar, Daniel Cherqui, Lorenzo Capussotti

Published in: World Journal of Surgery | Issue 12/2011

Abstract

Background

Management of patients with T3/4 and/or N+ mid/low rectal cancer with synchronous liver metastases is not codified. The aim of this study was to analyze outcomes of our approach which consists of neoadjuvant chemotherapy or chemoradiotherapy, according to liver disease extension, followed by simultaneous rectal and liver resection.

Methods

Between 2000 and 2009, 354 patients underwent hepatectomy for synchronous metastases. Thirty-six consecutive patients who underwent rectal and liver resection for metastatic T3/4 and/or N+ mid/low rectal cancer were analyzed.

Results

Liver metastases were multiple in 27 patients, bilobar in 22, and >5 cm in six. Up-front treatment was chemotherapy in 15 patients, chemoradiotherapy in seven, chemotherapy followed by chemoradiotherapy in six, and surgery in eight (five symptomatic tumors). After chemotherapy alone (median number of cycles = 6), primary tumor response was observed in 11 patients (three complete responses). After chemoradiotherapy, only one patient had liver disease progression. Eighty-nine percent of patients underwent simultaneous rectal and hepatic resection. Mortality and morbidity rates were 2.8% (one pulmonary embolism) and 36%, respectively. After a mean follow-up of 39 months, 5-year overall and disease-free survival were 59.3 and 39.6%, respectively. Twenty-one patients had recurrence, including three pelvic recurrences (8.3%). No pelvic recurrence occurred among patients who correctly completed treatment strategy. All patients who received neoadjuvant chemoradiotherapy were alive and disease-free; 5-year overall and disease-free survival of patients receiving neoadjuvant chemotherapy were 59.3 and 25%, respectively.

Conclusions

For patients with metastatic T3/4 and/or N+ mid/low rectal cancer, the present strategy was safe and effective. Good disease control was achieved by neoadjuvant treatments, low morbidity rates were associated with simultaneous resection, and excellent long-term outcomes with low local relapse rate were obtained.

Manfredi S, Lepage C, Hatem C et al (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259PubMedCrossRef

Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRef

Viganò L, Ferrero A, Lo Tesoriere R et al (2008) Liver surgery for colorectal metastases: results after 10 years of follow-up. Long-term survivors, late recurrences, and prognostic role of morbidity. Ann Surg Oncol 15:2458–2464PubMedCrossRef

Capussotti L, Vigano’ L, Ferrero A et al (2007) Timing of resection of liver metastases synchronous to colorectal tumor: proposal of prognosis-based decisional model. Ann Surg Oncol 14:1143–1150PubMedCrossRef

de Santibanes E, Lassalle FB, McCormack L et al (2002) Simultaneous colorectal and hepatic resections for colorectal cancer: postoperative and longterm outcomes. J Am Coll Surg 195:196–202PubMedCrossRef

Weber JC, Bachellier P, Oussoultzoglou E et al (2003) Simultaneous resection of colorectal primary tumour and synchronous liver metastases. Br J Surg 90:956–962PubMedCrossRef

Allen PJ, Kemeny N, Jarnagin W et al (2003) Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases. J Gastrointest Surg 7:109–115PubMedCrossRef

Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987

Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRef

10.

Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef

11.

Gérard JP, Conroy T, Bonnetain F et al (2006) Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–4625PubMedCrossRef

12.

Sauer R, Becker H, Hohenberger W et al (2004) German Rectal Cancer Study Group. Preoperative versus postoperative chemo-radiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef

13.

Douillard JY, Cunningham D, Roth AD et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355:1041–1047PubMedCrossRef

14.

de Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947PubMed

15.

O’Neil BH, Tepper JE (2007) Current options for the management of rectal cancer. Curr Treat Options Oncol 8(5):331–338PubMedCrossRef

16.

Willett CG, Duda DG, di Tomaso E et al (2007) Complete pathological response to bevacizumab and chemoradiation in advanced rectal cancer. Nat Clin Pract Oncol 4:316–321PubMedCrossRef

17.

Ceelen W, Fierens K, Van Nieuwenhove Y et al (2009) Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis. Int J Cancer 124:2966–2972PubMedCrossRef

18.

Glynne-Jones R, Harrison M (2007) Locally advanced rectal cancer: what is the evidence for induction chemoradiation? Oncologist 12:1309–1318PubMedCrossRef

19.

Chau I, Brown G, Cunningham D et al (2006) Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. J Clin Oncol 24:668–674PubMedCrossRef

20.

Mentha G, Majno PE, Andres A et al (2006) Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg 93:872–878PubMedCrossRef

21.

Mentha G, Roth AD, Terraz S et al (2008) ‘Liver first’ approach in the treatment of colorectal cancer with synchronous liver metastases. Dig Surg 25(6):430–435PubMedCrossRef

22.

Verhoef C, van der Pool AE, Nuyttens JJ et al (2009) The “liver-first approach” for patients with locally advanced rectal cancer and synchronous liver metastases. Dis Colon Rectum 52(1):23–30PubMedCrossRef

23.

Capussotti L, Ferrero A, Viganò L et al (2007) Major liver resections synchronous with colorectal surgery. Ann Surg Oncol 14:195–201PubMedCrossRef

24.

Cherqui D, Malassagne B, Colau PI et al (1999) Hepatic vascular exclusion with preservation of the caval flow for liver resections. Ann Surg 230:24–30PubMedCrossRef

25.

Chouillard E, Cherqui D, Tayar C et al (2003) Anatomical bi- and trisegmentectomies as alternatives to extensive liver resections. Ann Surg 238:29–34PubMed

26.

Ferrero A, Viganò L, Lo Tesoriere R et al (2009) Bisegmentectomies as alternative to right hepatectomy in the treatment of colorectal liver metastases. Hepatogastroenterology 56(94–95):1429–1435PubMed

27.

Balzan S, Belghiti J, Farges O et al (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828PubMedCrossRef

28.

Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer: a randomised controlled trial. Lancet 371(9617):1007–1016PubMedCrossRef

29.

Klautke G, Fietkau R (2007) Intensified neoadjuvant radiochemotherapy for locally advanced rectal cancer: a review. Int J Colorectal Dis 22:457–465PubMedCrossRef

30.

Benoist S (2007) Recommendations for clinical practice. Therapeutic choices for rectal cancer. How should rectal cancers with synchronous metastases be managed? Gastroenterol Clin Biol 31(1):1S75–80, S100–102

31.

Reddy SK, Zorzi D, Lum YW et al (2009) Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis. Ann Surg Oncol 16(7):1809–1819PubMedCrossRef

32.

Minagawa M, Yamamoto J, Miwa S et al (2006) Selection criteria for simultaneous resection in patients with synchronous liver metastasis. Arch Surg 141(10):1006–1012PubMedCrossRef

33.

Adam R, Pascal G, Castaing D et al (2004) Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg 240(6):1052–1061PubMedCrossRef

34.

Parikh AA, Gentner B, Wu TT et al (2003) Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy. J Gastrointest Surg 7(8):1082–1088PubMedCrossRef

35.

Tanaka K, Adam R, Shimada H et al (2003) Role of neoadjuvant chemotherapy in the treatment of multiple colorectal metastases to the liver. Br J Surg 90:963–996PubMedCrossRef

36.

Karoui M, Koubaa W, Delbaldo C et al (2008) Chemotherapy has also an effect on primary tumor in colon carcinoma. Ann Surg Oncol 15:3440–3446PubMedCrossRef

37.

Martin R, Paty P, Fong Y et al (2003) Simultaneous liver and colorectal resections are safe for synchronous colorectal liver metastasis. J Am Coll Surg 197:233–241PubMedCrossRef

38.

Reddy SK, Pawlik TM, Zorzi D et al (2007) Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 14(12):3481–3491PubMedCrossRef

39.

Paun BC, Cassie S, MacLean AR et al (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251(5):807–818PubMedCrossRef

40.

Thelen A, Jonas S, Benckert C et al (2007) Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis 22(10):1269–1276PubMedCrossRef

Title: Locally Advanced Mid/Low Rectal Cancer with Synchronous Liver Metastases
Authors: Luca Viganò
Mehdi Karoui
Alessandro Ferrero
Claude Tayar
Daniel Cherqui
Lorenzo Capussotti
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-011-1272-7

At a glance: The STEP trials

Springer Medicine

Locally Advanced Mid/Low Rectal Cancer with Synchronous Liver Metastases

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2011

Multivisceral Resections in Pancreatic Cancer: Identification of Risk Factors

Predictive Value of Baseline Neutrophil/Lymphocyte Ratio for T4 Disease in Wall-Penetrating Gastric Cancer

Elevation of Liver Function Tests After Laparoscopic Gastrectomy Using a Nathanson Liver Retractor

The Impact of Heavy Smoking on Anastomotic Leakage and Stricture After Low Anterior Resection in Rectal Cancer Patients

Improved Lymph Node Harvest from Resected Colon Cancer Specimens Did Not Cause Upstaging from TNM Stage II to III

Indications for Staging Laparoscopy in Clinical T4M0 Gastric Cancer