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The "Liver-First Approach" for Patients with Locally Advanced Rectal Cancer and Synchronous Liver Metastases

Verhoef, Cornelis M.D., Ph.D.1; van der Pool, Anne E. M. M.D.1; Nuyttens, Joost J. M.D., Ph.D.2; Planting, Andre S. T. M.D., Ph.D.3; Eggermont, Alexander M. M. M.D., Ph.D.1; de Wilt, Johannes H. W. M.D., Ph.D.1

Diseases of the Colon & Rectum: January 2009 - Volume 52 - Issue 1 - p 23-30
doi: 10.1007/DCR.0b013e318197939a
ORIGINAL CONTRIBUTIONS
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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, 7-56) 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.

1 Department of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

2 Department of Radiotherapy, Erasmus University MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

3 Department of Medical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

Dr. Verhoef has received an unrestricted grant from Sanofi-aventis.

Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008.

Reprints are not available.

Address of correspondence: Cornelis Verhoef, M.D., Ph.D., Department of Surgical Oncology, Erasmus University MC-Daniel den Hoed Cancer Center, PO Box 5201, 3008 AE Rotterdam, The Netherlands. E-mail: c.verhoef@erasmusmc.nl

© The ASCRS 2009