Abstract
The management of the primary lesion in patients with stage IV adenocarcinoma of the distal rectum is controversial. An abdominoperineal resection (APR) may be a good option. A retrospective analysis of the medical records of 21 patients with stage IV distal rectal adenocarcinoma treated with an APR between January 1991 to December 2000 was performed. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 and normal preoperative alkaline phosphatase and total bilirubin levels. Twelve patients (92%) with liver metastases had less than 25% of total liver volume involvement. Twenty patients (95%) had complete resolution of their symptoms related to the primary rectal cancer. The median follow-up was 19 months (range 3-92 months), with a median survival of 21.6 months and a 2-year overall survival of 34%. Patients with stage IV distal rectal adenocarcinoma who have a good performance status, normal preoperative liver function tests, and minimal metastatic disease to the liver can be offered resective surgery.
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