What Are the Surgical Options in Patients with Synchronous Rectal Cancer?
Approximately 20–25% of patients with rectal cancer present with metastatic disease at the time of diagnosis. The incidence of metastases varies between different stages, where patients with locally advanced or node-positive tumors have a higher risk for
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Johannes H.W. de Wilt, Martinus J. van Amerongen, and Jorine ‘t Lam-Boer
53.1 Introduction Approximately 20–25% of patients with colorectal cancer present with metastatic disease at the time of diagnosis [1, 2]. The incidence of metastases varies between different stages, where patients with locally advanced or node-positive tumors have a higher risk for metastatic disease compared to patients with early tumors. The risk and pattern of metastasis are also highly dependent on location of the colorectal tumor and histological subtype. As an example, histological subtypes such as mucinous adenocarcinoma have more often peritoneal metastases, and signet ring cell tumors have more often distant lymph node metastases [3]. Lung metastases are more often found in rectal cancer patients as compared to colon cancer patients, and the incidence is increasing over time, probably due to current improvements in imaging techniques [2].
J.H.W. de Wilt (*) • J. ‘t Lam-Boer Department of Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands e-mail: [email protected] M.J. van Amerongen Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
Nowadays, nearly all colorectal cancer patients are staged with CT of the thorax, abdomen, and pelvis, whereas in the past only abdominal ultrasound and chest X-rays were performed. As a result, patients with rectal cancer and distant metastases are now accurately staged, and appropriate treatment regimens can be applied to each patient. Treatment of patients who present with rectal cancer and distant metastases depends primarily on the condition, age, and frailty of the patients, but obviously resectability of the primary tumor and the metastases is important. Involvement of modern multimodality treatment and thorough discussions in a multidisciplinary tumor board is important in optimizing patient outcome [4].
53.2 Rectal Cancer with Resectable Metastases The majority of patients with metastases who undergo treatment of both the primary and the metastases have liver metastases. There are many papers in the literature describing results of patients undergoing resection for liver metastases with overall survival rates of 30–60% depending on the characteristics of the study population [5– 8]. Various factors for the selection of patients who benefit most of resection have been described [9–11]. The most well-known clinical criteria are those established by Fong, which contains the
© Springer-Verlag Berlin Heidelberg 2018 V. Valentini et al. (eds.), Multidisciplinary Management of Rectal Cancer, https://doi.org/10.1007/978-3-319-43217-5_53
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following risk factors: a CEA level >200 ng/ml, the node positivity of the primary tumor, number of liver metastases (>1) and size of the metastases (>5 cm), and a disease-free interval between primary tumor and metastases shorter than 12 months [10]. This last item is also included in this risk score, bec
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