title: Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases.
abstract: BACKGROUND
  This study evaluated the outcome of patients treated for rectal cancer and synchronous hepatic metastases in the era of effective induction radiotherapy and chemotherapy.
  
  
  METHODS
  All patients undergoing surgical treatment of rectal cancer and synchronous liver metastases between 2000 and 2007 were identified retrospectively from a prospectively collected database. Three approaches were followed: the classical staged, the simultaneous and the liver-first approach.
  
  
  RESULTS
  Of 57 patients identified, the primary tumour was resected first in 29 patients (group 1), simultaneous resection was performed in eight patients (group 2), and 20 patients underwent a liver-first approach (group 3). The overall morbidity rate was 24.6 per cent; there was no in-hospital mortality. Median in-hospital stay was significantly shorter for the simultaneous approach (9 days versus 18 and 15 days for groups 1 and 3 respectively; P < 0.001). The overall 5-year survival rate was 38 per cent, with an estimated median survival of 47 months.
  
  
  CONCLUSIONS
  Long-term survival can be achieved using an individualized approach, with curative intent, in patients with rectal cancer and synchronous liver metastases. Simultaneous resections as well as the liver-first approach are attractive alternatives to traditional staged resections.
authors.affiliation: Division of Surgical Oncology, Erasmus University MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: van der Pool
authors.forename: J H
authors.initials: JH
authors.lastname: de Wilt
authors.forename: Z S
authors.initials: ZS
authors.lastname: Lalmahomed
authors.forename: A M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: J N
authors.initials: JN
authors.lastname: Ijzermans
authors.forename: C
authors.initials: C
authors.lastname: Verhoef
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D013997:Time Factors