Management of the Patient with Rectal Cancer Presenting with Synchronous Liver Metastasis
An estimated 39,610 new cases of rectal cancer (RC) are expected in the United States in 2015 [1]. Synchronous colorectal liver metastasis (SCRLM) occurs in 20 % of patients with locally advanced RC [2, 3]. Median overall survival (OS) for patients with S
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Management of the Patient with Rectal Cancer Presenting with Synchronous Liver Metastasis Shafik M. Sidani and Maher A. Abbas
Introduction An estimated 39,610 new cases of rectal cancer (RC) are expected in the United States in 2015 [1]. Synchronous colorectal liver metastasis (SCRLM) occurs in 20 % of patients with locally advanced RC [2, 3]. Median overall survival (OS) for patients with SCRLM is 20–24 months without resection as opposed to 5-year OS of up to 50 % with R0 resection of metastatic disease [4]. Oncologic outcomes continue to improve with the development of new effective chemotherapy regimens and increased hepatectomy rates [5, 6]. Patients with SCRLM constitute a heterogeneous group with varying preoperative fitness, tumor biology, tumor resectability, and symptomatology related to the primary tumor. Potential cure is dependent on the ability to resect all disease, and requires a multidisciplinary approach. Locally advanced RC requires chemoradiation (CRT) with surgery, whereas SCRLM is initially addressed with chemotherapy. Surgery for symptomatic relief is reserved for select cases. The optimal sequence of multimodality treatment to address the primary tumor and associated metastatic disease is under active investigation.
S.M. Sidani (*) • M.A. Abbas Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates e-mail: [email protected]
© Springer International Publishing Switzerland 2017 N. Hyman, K. Umanskiy (eds.), Difficult Decisions in Colorectal Surgery, Difficult Decisions in Surgery: An Evidence-Based Approach, DOI 10.1007/978-3-319-40223-9_20
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S.M. Sidani and M.A. Abbas
Search Strategy An electronic search was conducted using the PubMed database for reports published in the English language between January 1990 and October 2015 using the key words rectal cancer in various combinations with liver metastasis(es), hepatic metastasis(es), staged resection, simultaneous resection, synchronous resection, combined resection, liver-first, chemotherapy, and radiation. Referenced studies from identified reports were reviewed if relevant. The “related articles” function was used to further expand the search. Only studies published between 2000 and 2015 clearly identifying at least 20 patients with RC and synchronous liver metastases were included in the tables summarizing the studies. If more than one study was reported from the same institution, the most recent study focusing on RC was included. Patient population Patients with RC and SCRLM
Intervention Staged rectum-first approach
Comparator Liver-first approach Simultaneous resections approach
Outcomes studied Perioperative morbidity Disease free survival (DFS) OS
Results valuation of the Patient with Rectal Cancer and Synchronous E Hepatic Metastasis The initial evaluation of patients with rectal cancer and SCRLM includes determination of symptomatology, colonoscopy, staging, determination of resectability from an oncologic standpoint, and evaluation of the future liver remnant based on ima
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