Rectal outcomes after a liver-first treatment of patients with stage IV rectal cancer

BACKGROUND The treatment of patients with metastatic rectal cancer remains controversial. We developed a reverse strategy the liver first approach to optimize the chance of a curative resection. The aim of this study was to assess rectal outcomes after reverse treatment of patients with metastatic rectal cancer. METHODS From May 2000 to November 2013 a total of 34 consecutive selected patients with histology proven adenocarcinoma of the rectum and liver metastases were prospectively entered into a dedicated computerized database. All patients were treated via our reverse strategy. Rectal and overall survival outcomes were analyzed. RESULTS Most patients presented with advanced disease (median Fong clinical risk score of 3; range 2 5). One patient failed to complete the whole treatment (3 ). Rectal surgery was performed after a median of 3.9 months (range 0.4 17.8 months). A total of 73.3 patients received preoperative radiotherapy. Perioperative mortality and morbidity rates were 0 and 27.3 after rectal surgery. Severe complications were reported in two patients (6.1 ): one anastomotic leak and one systemic inflammatory response syndrome. The median hospital stay was 11 days (range 5 23 days). Complete local pathological response was observed in three patients (9.1 ). The median number of lymph nodes collected was 14. The R0 rate was 93.9 . There was no positive circumferential margin. After a mean follow up of 36 months after rectal surgery 5 year overall survival was 52.5 . Five patients experienced pelvic recurrence. CONCLUSIONS In our cohort of selected patients with stage IV rectal cancer the reverse strategy was not only safe and effective but also oncologically promising with a low morbidity rate and high long term survival.