Treatment strategies for rectal cancer with synchronous liver metastases: surgical and oncological outcomes with propensity-score analysis

Abstract

The optimal sequence of surgery for rectal cancer (RC) with synchronous liver metastases (SLM) is controversial. The primary objective was to explore differences between the rectum first (RF) and the liver first strategy (LF) to achieve the complete resection (CR) of both tumors. Patients diagnosed of RC with resectable or potentially resectable SLM were included. Data collected prospectively were analyzed with an intention-to-treat perspective, adjusting for between-sample differences (propensity score). The complete resection rate (CRR) was the main outcome variable. During a 5-year period, 23 patients underwent the LF strategy and 24 patients the RF strategy. Median overall survival (OS) was 32months in the LF group and 41months in the RF group (p=0.499), and was 51 and 17months, respectively, for patients achieving or not achieving CR of both tumors (p<0.001). CRR's were 65% in liver first group and 63% in rectum first group, (p=0.846). No between-strategy differences in morbidity or duration of treatment were observed. This study supports the notion that the achievement of CR of RC and SLM should be the goal of oncological treatment. Both RF and LF strategies are feasible and safe, but no between-strategy differences have been found in the CRR.