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Introduction: One in ten patients with rectal cancer presents with synchronous colorectal liver metastases. We present an up-to-date review of the different surgical strategies available for rectal cancer patients with synchronous colorectal liver metastases. Method: A literature review of MEDLINE, Cochrane and Google scholar was performed. Results: Twenty retrospective studies comparing staged versus simultaneous resections were found. Overall survival was similar for both approaches whilst the length of stay was decreased in simultaneous resections. Only two studies comparing the 'reverse' versus staged or simultaneous resections were found. The studies investigating resection versus non-resection for rectal primaries with unresectable liver metastases were limited. Conclusion: Simultaneous resections are a reasonable alternative to staged resections for either advanced rectal cancers with limited liver disease or early rectal cancers with extensive liver disease. Currently, staged resections are favoured over simultaneous resections in patients with locally advanced rectal cancers with extensive liver disease. There are too few studies to determine the safety of reverse resections in the context of locally advanced rectal cancers. A resection of the primary tumour or a non-surgical intervention can be justified in the management of the rectal cancer primary in the presence of unresectable liver metastases. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to compare the diagnostic ability of blood markers for colorectal cancer (CRC). A systematic review of the literature for diagnostic blood markers for primary human colorectal cancer over the last 5 years was performed. The primary outcome was to assess the diagnostic ability of these markers in diagnosing colorectal cancer. The secondary outcome was to see whether the marker was compared to other markers. The tertiary outcome was to assess diagnostic ability in early versus late CRC, including stage IV disease. We identified 51 studies (29 prospective, 14 retrospective, and 8 meta-analyses). The markers were divided in broadly four groups: nucleic acids (RNA/DNA/messenger RNA/microRNAs), cytokines, antibodies, and proteins. The most promising circulating markers identified among the nucleid acids were NEAT_v2 non-coding RNA, SDC2 methylated DNA, and SEPT9 methylated DNA. The most promising cytokine to detect CRC was interleukin 8, and the most promising circulating proteins were CA11-19 glycoprotein and DC-SIGN/DC-SIGNR. Sensitivities of these markers for detecting primary colorectal carcinoma ranged from 70 to 98% and specificities from 84 to 98.7%. The best studied blood marker was SEPT9 methylated DNA, which showed great variability with sensitivities ranging from 48.2 to 95.6% and specificities from 80 to 98.9%, making its clinical applicability challenging. If combined with fecal immunochemical test (FIT), the sensitivity improved from 78 to 94% in detecting CRC. Methylated SEPT9, methylated SDC2, and -SIGN/DC-SIGNR protein had better sensitivity and specificity than CEA or CA 19-9. With the exception of SEPT9 which is currently being implemented as a screening test for CRC all other markers lacked reproducibility and standardization and were studied in relatively small population samples.