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Clinical and Translational Oncology

, Volume 20, Issue 8, pp 1018–1025 | Cite as

Oncological strategies for locally advanced rectal cancer with synchronous liver metastases, interval strategy versus rectum first strategy: a comparison of short-term outcomes

  • H. Salvador-Rosés
  • S. López-Ben
  • M. Casellas-Robert
  • P. Planellas
  • N. Gómez-Romeu
  • R. Farrés
  • E. Ramos
  • A. Codina-Cazador
  • J. Figueras
Research Article

Abstract

Background

The goal of treatment for patients with synchronous liver metastases (SLM) from rectal cancer is to achieve a complete resection of both tumor locations. For patients with symptomatic locally advanced rectal cancer with resectable SLM at diagnosis, our usual strategy has been the rectum first approach (RF). However, since 2014, we advocate for the interval approach (IS) that involves the administration of chemo-radiotherapy followed by the resection of the SLM in the interval of time between rectal cancer radiation and rectal surgery.

Methods

From 2010 to 2016, 16 patients were treated according to this new strategy and 19 were treated according RF strategy. Data were collected prospectively and analyzed with an intention-to-treat perspective. Complete resection rate, duration of the treatment and morbi-mortality were the main outcomes.

Results

The complete resection rate in the IS was higher (100%, n = 16) compared to the RF (74%, n = 14, p = 0.049) and the duration of the strategy was shorter (6 vs. 9 months, respectively, p = 0.006). The incidence of severe complications after liver surgery was 14% (n = 2) in the RF and 0% in the IS (p = 1.000), and after rectal surgery was 24% (n = 4) and 12% (n = 2), respectively (p = 1.000).

Conclusion

The IS is a feasible and safe strategy that procures higher level of complete resection rate in a shorter period of time compared to RF strategy.

Keywords

Rectal cancer Synchronous liver metastases Rectum first strategy Interval strategy 

Abbreviations

SLM

Synchronous liver metastases

RF

Rectum first strategy

IS

Interval strategy

OS

Overall survival

CEA

Carcinoembryonic antigen

CT

Computed tomography

MR

Magnetic resonance

ChR

Chemo-radiotherapy

DFS

Disease-free survival

Notes

Acknowledgements

To the Dr. Trueta Hospital Cancer Registry and to the Multidisciplinary Digestive Tumor Board, for their help.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by The Dr. Josep Trueta University Hospital's ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  1. 1.Department of Digestive SurgeryDoctor Josep Trueta University Hospital, IdIBGiGironaSpain
  2. 2.Department of Digestive Surgery, Bellvitge HospitalUniversity of BarcelonaBarcelonaSpain
  3. 3.University of BarcelonaBarcelonaSpain

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