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Purposes: In rectal cancer, the incidence of synchronous liver metastases (SLM) ranges from 14% to 30%. The treatment of SLM combines neo-adjuvant chemo- and/or radiotherapy with of one three surgical resection strategies (rectal resection first, liver resection first or simultaneous resection). The present study evaluated the success rate for each resection strategy., Methods: From January 2005 to December 2013, we retrospectively included all patients with distal (middle and low) rectal cancer (MLRC) and SLM and who had been operated on with curative intent. The primary study endpoint was the proportion of complete resections at both tumour sites. The secondary endpoints were postoperative morbidity, the long-term outcome and risk factors for incomplete resection., Results: 52 patients were included. There were no significant intergroup differences in the incidence of complete resection (respectively 74%, 66% and 50% in the rectum-first (n = 20), simultaneous (n = 10) and liver-first groups (n = 5); p = 0.3), the overall complication rate or mortality rate after rectal resection (p = 0.5) or liver resection (p = 0.8), overall survival (60, 47 and 38 months, respectively; p = 0.4) or disease-free survival (31, 32 and 7.8 months, respectively; p = 0.1). Emergency surgery was the only risk factor for treatment failure (p = 0.01)., Conclusion: There were no differences in short and long-term outcomes between the three strategies. No one oncological strategy should be favoured for all cases of MLRC with SLM. The strategy should be choosen, based on the oncological emergency (rectum-first or liver-first), predictive factors for morbidity in rectal surgery and MDT discussion., (Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.)

Background: Meticulous assessment of the left liver for patients scheduled for right hepatectomy is essential. Endoscopic ultrasonography (EUS) is frequently used for the locoregional staging or biopsy of pancreatic tumours and has shown some value in the evaluation of the left liver., Methods: We prospectively enrolled 24 consecutive patients who were scheduled for at least a right hepatectomy and who underwent laparotomy for colorectal liver metastasis (CLMs). The left liver was assessed preoperatively with standard techniques [computed tomography (CT) scan, percutaneous ultrasonography] and EUS. These results were compared with those of intraoperative ultrasonography (IOUS)., Results: The study population consisted of 12 men and 12 women (mean age 64 years, range 47-79 years). Mean body mass index was 26 kg/m(2) (range 20-35 kg/m(2)). Standard preoperative evaluation detected 28 lesions in the left liver; EUS detected just 17 lesions, whereas IOUS detected 30 lesions in the left liver. For the left lobe of the liver (segments II and III), the standard evaluation had sensitivity of 85%, specificity of 64%, positive predictive value (PPV) of 50% and negative predictive value (NPV) of 91%; EUS had sensitivity of 55%, specificity of 86%, PPV of 71% and NPV of 76%; IOUS had sensitivity of 85.2%, specificity of 92%, PPV of 96.6% and NPV of 75%. In terms of the left liver (i.e. segments II, III and IV), the results of EUS were less good than for the left lobe of the liver., Conclusion: For segments II and III, EUS had higher specificity and positive predictive value than standard evaluation, but only changed our therapeutic strategy in three cases. Even though EUS can provide some valuable information, the technique is not accurate enough to merit systematic performance as part of a standard preoperative evaluation. This study underlines the main role of IOUS in the left liver, with better sensitivity, specificity, and positive predictive value than EUS and standard evaluation.