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

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.

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.

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.

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.