The liver-first approach for locally advanced rectal cancer and synchronous liver metastases

Background:Patients with locally advanced rectal cancer (LARC) and synchronous liver metastases(sRLM) can be treated according to the liver-first approach. This study aimed to evaluate prognosticfactors for completing treatment and in how many patients extensive lower pelvic surgery might havebeen omitted.Methods:Retrospective analysis of all patients with LARC and sRLM treated at the Erasmus MC CancerInstitute according to the liver-first between 2003 and 2016.Results:In total 129 consecutive patients were included. In 90 patients (70%) the liver-first wascompleted. Ten patients had a (near) complete response (ypT0-1N0) of their primary tumour. In 36 out of39 patientsnotcompleting the liver-first protocol palliative rectum resection was withheld. Optimal cut-offs for CEA level (53.15mg/L), size (3.85 cm) and number (4) of RLMs were identified. A preoperative CEAlevel above 53.15mg/L was an independent predictor for non-completion of the liver-first protocol(p¼0.005).Conclusion:Ten patients had a (near) complete response of their primary tumour and, in retrospect,rectum sparing therapies could have been considered. Together with 36 patient in whom palliativerectum resection was not necessary this entails that nearly 40% patients with LARC and sRLM might bespared major pelvic surgery if the liver-first approach is applied. A predictor (CEA) was found for non-completion of the liver-first protocol. The majority of patients underwent resection of both primarytumour and hepatic metastasis with curative intent. Thesefindings together entail that the liver-firstapproach may be considered in patients with LARC and sRLM.©2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of SurgicalOncology. All rights reserved.