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

Buchs, Nicolas ; Ris, Frédéric ; Majno, Pietro ; Andres, Axel ; Cacheux, Wulfran ; Gervaz, Pascal ; Roth, Arnaud ; Terraz, Sylvain ; Rubbia-Brandt, Laura ; Morel, Philippe ; Mentha, Gilles ; Toso, Christian

In: Annals of Surgical Oncology, 2015, vol. 22, no. 3, p. 931-937

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    Titre
    • Rectal Outcomes After a Liver-First Treatment of Patients with Stage IV Rectal Cancer
    Auteur
    • Buchs, Nicolas. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Ris, Frédéric. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Majno, Pietro. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Andres, Axel. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Cacheux, Wulfran. Gastrointestinal Tumor Unit, Center of Oncology, University Hospital of Geneva, Geneva, Switzerland
    • Gervaz, Pascal. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Roth, Arnaud. Hepato-Pancreato-Biliary Center, Geneva, Switzerland
    • Terraz, Sylvain. Hepato-Pancreato-Biliary Center, Geneva, Switzerland
    • Rubbia-Brandt, Laura. Hepato-Pancreato-Biliary Center, Geneva, Switzerland
    • Morel, Philippe. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Mentha, Gilles. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    • Toso, Christian. Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Geneva, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Annals of Surgical Oncology, 2015, vol. 22, no. 3, p. 931-937. Springer US; http://www.springer-ny.com
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:331149
    Summary
    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 3.9months (range 0.4-17.8months). 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 11days (range 5-23days). 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 36months 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.