title: The "liver-first approach" for patients with locally advanced rectal cancer and synchronous liver metastases.
abstract: OBJECTIVE
  This study was designed to investigate the outcome of "the liver-first" approach in patients with locally advanced rectal cancer and synchronous liver metastases.
  
  
  METHODS
  Patients with locally advanced rectal cancer and synchronous liver metastases were primarily treated for their liver metastases. If successful, patients underwent treatment for the rectal tumor.
  
  
  RESULTS
  Twenty-three patients were included. One patient had liver resection without neoadjuvant chemotherapy followed by chemoradiotherapy. All remaining 22 patients underwent laparotomy after chemotherapy. Eighteen patients underwent partial liver resection and subsequent chemoradiotherapy for the rectal cancer. One patient underwent in one session a partial liver resection and a low anterior resection. Six patients were not treated according to protocol because of extensive disease. Sixteen patients (73 percent) completed the full treatment protocol and all are alive after a median period of 19 (range, 7-56) months.
  
  
  CONCLUSIONS
  This is the first sizable report on the "liver-first approach" demonstrating that it may be considered the preferred treatment schedule for patients with locally advanced rectal cancer and synchronous liver metastases. It allows most patients to undergo curative resections of both metastatic and primary disease and can avoid useless rectal surgery in patients with incurable metastatic disease.
authors.affiliation: Department of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. c.verhoef@erasmusmc.nl
authors.forename: Cornelis
authors.initials: C
authors.lastname: Verhoef
authors.forename: Anne E M
authors.initials: AE
authors.lastname: van der Pool
authors.forename: Joost J
authors.initials: JJ
authors.lastname: Nuyttens
authors.forename: Andre S T
authors.initials: AS
authors.lastname: Planting
authors.forename: Alexander M M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007813:Laparotomy; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D017211:Treatment Failure