Locally advanced mid/low rectal cancer with synchronous resectable liver metastases: systematic review of the available strategies and outcome.
R TutinoA BonomiC C ZingarettiL RisiE M RagainiLuca ViganoM PaternoI PezzoliPublished in: Updates in surgery (2024)
The management of patients with locally advanced mid/low rectal cancer with resectable liver metastases is complex because of the need to combine the optimal treatment of both tumors. This study aims to review the available treatment strategies and compare their outcome, focusing on radiotherapy (RT) and liver-first approach (LFA). A systematic review was performed in PubMed, Embase, and web sources including articles published between 2000 and 02/2023 and reporting mid-/long-term outcomes. Overall, twenty studies were included (n = 1837 patients). Three- and 5-year overall survival (OS) rates were 51-88% and 36-59%. Although several strategies were reported, most patients received RT (1448/1837, 79%; > 85% neoadjuvant). RT reduced the pelvic recurrence risk (5.8 vs. 13.5%, P = 0.005) but did not impact OS. Six studies analyzed LFA (n = 307 patients). LFA had a completion rate similar to the rectum-first approach (RFA, 81% vs. 79%) but the interval strategy-an LFA variant with liver surgery in the interval between radiotherapy and rectal surgery-had a better completion rate than standard LFA (liver surgery/radiotherapy/rectal surgery, 92% vs. 75%, P = 0.011) and RFA (79%, P = 0.048). Across all series, LFA achieved the best survival rates, and in one paper it led to a survival advantage in patients with multiple metastases. In conclusion, different strategies can be adopted, but RT should be included to decrease the pelvic recurrence risk. LFA should be considered, especially in patients with high hepatic tumor burden, and RT before liver surgery (interval strategy) could maximize its completion rate.
Keyphrases
- locally advanced
- rectal cancer
- neoadjuvant chemotherapy
- end stage renal disease
- minimally invasive
- liver metastases
- systematic review
- squamous cell carcinoma
- phase ii study
- radiation therapy
- ejection fraction
- coronary artery bypass
- chronic kidney disease
- newly diagnosed
- peritoneal dialysis
- prognostic factors
- early stage
- emergency department
- surgical site infection
- patient reported outcomes
- radiation induced
- risk factors
- acute coronary syndrome
- coronary artery disease
- atrial fibrillation
- drug induced
- electronic health record
- study protocol