PURPOSE: This study was designed to investigate the outcome of ''the liver-first'' approach in patients with locally advanced rectal cancer and synchronous liver metastases. METHODS: Patients with locally advanced rectal cancer and synchronous liver metastases were primarily treated for their liver metastases. If successful, patients underwent treatment for the rectal tumor. RESULTS: Twenty-three patients were included. One patient had liver resection without neoadjuvant chemotherapy followed by chemoradiotherapy. All remaining 22 patients underwent laparotomy after chemotherapy. Eighteen patients underwent partial liver resection and subsequent chemoradiotherapy for the rectal cancer. One patient underwent in one session a partial liver resection and a low anterior resection. Six patients were not treated according to protocol because of extensive disease. Sixteen patients (73 percent) completed the full treatment protocol and all are alive after a median period of 19 (range, 7Y56) months. CONCLUSIONS: This is the first sizable report on the ''liver-first approach'' demonstrating that it may be considered the preferred treatment schedule for patients with locally advanced rectal cancer and synchronous liver metastases. It allows most patients to undergo curative resections of both metastatic and primary disease and can avoid useless rectal surgery in patients with incurable metastatic disease.

Additional Metadata
Keywords Liver-first approach, Locally advanced rectal cancer, Synchronous liver metastases
Persistent URL dx.doi.org/10.1007/DCR.0b013e318197939a, hdl.handle.net/1765/25014
Journal Diseases of the Colon and Rectum
Citation
Verhoef, C, van der Pool, A.E.M, Nuyttens, J.J.M.E, Planting, A.S.T, Eggermont, A.M.M, & de Wilt, J.H.W. (2009). The 'liver-first approach' for patients with locally advanced rectal cancer and synchronous liver metastases. Diseases of the Colon and Rectum, 52(1), 23–30. doi:10.1007/DCR.0b013e318197939a