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Treatment strategies for rectal cancer with synchronous liver metastases: surgical and oncological outcomes with propensity-score analysis

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Abstract

Background

The optimal sequence of surgery for rectal cancer (RC) with synchronous liver metastases (SLM) is controversial.

Objectives

The primary objective was to explore differences between the rectum first (RF) and the liver first strategy (LF) to achieve the complete resection (CR) of both tumors.

Methods

Patients diagnosed of RC with resectable or potentially resectable SLM were included. Data collected prospectively were analyzed with an intention-to-treat perspective, adjusting for between-sample differences (propensity score). The complete resection rate (CRR) was the main outcome variable.

Results

During a 5-year period, 23 patients underwent the LF strategy and 24 patients the RF strategy. Median overall survival (OS) was 32 months in the LF group and 41 months in the RF group (p = 0.499), and was 51 and 17 months, respectively, for patients achieving or not achieving CR of both tumors (p < 0.001). CRR’s were 65% in liver first group and 63% in rectum first group, (p = 0.846). No between-strategy differences in morbidity or duration of treatment were observed.

Conclusions

This study supports the notion that the achievement of CR of RC and SLM should be the goal of oncological treatment. Both RF and LF strategies are feasible and safe, but no between-strategy differences have been found in the CRR.

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Abbreviations

RC:

Rectal cancer

SLM:

Synchronous liver metastases

LF:

Liver first

RF:

Rectum first

CR:

Complete resection

CRR:

Complete resection rate

OS:

Overall survival

CEA:

Carcinoembryonic antigen

CT:

Computed tomography

MR:

Magnetic resonance

ChR:

Chemo-radiotherapy

DFS:

Disease free survival

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Acknowledgements

To the Dr. Trueta Hospital Cancer Registry and to the Multidisciplinary Digestive Tumor Board, for their help; and to Maria Buxó for her help in the statistical analysis. The College of Physicians of Girona supported this research.

Sources of funding for research

Research grant of the College of Physicians of Girona (COMG: Col·legi Oficial de Metges de Girona). Institut d’Investigacions Biomédiques de Girona. (IdIBGi).

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Authors and Affiliations

  1. Department of Digestive Surgery, Doctor Josep Trueta University Hospital, IdIBGi, Avinguda de França, S/N, 17007, Girona, Spain

    H. Salvador-Rosés, S. López-Ben, P. Planellas, M. Casellas-Robert, R. Farrés, A. Codina-Cazador & J. Figueras

  2. Section of Radiotherapy, Institut Catala de Oncologia, “Doctor Josep Trueta” University Hospital, IdIBGi, Girona, Spain

    E. Canals

  3. Department of Digestive Surgery, Bellvitge Hospital, University of Barcelona, Barcelona, Spain

    E. Ramos

  4. University of Barcelona, Barcelona, Spain

    H. Salvador-Rosés, M. Casellas-Robert & J. Figueras

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  1. H. Salvador-Rosés
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Correspondence to H. Salvador-Rosés.

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The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by the University Hospital Dr. Josep Trueta 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.

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This paper has not been based on a previous communication to a society or meeting.

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Salvador-Rosés, H., López-Ben, S., Planellas, P. et al. Treatment strategies for rectal cancer with synchronous liver metastases: surgical and oncological outcomes with propensity-score analysis. Clin Transl Oncol 20, 221–229 (2018). https://doi.org/10.1007/s12094-017-1712-4

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  • DOI: https://doi.org/10.1007/s12094-017-1712-4

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