title: Synchronous rectal and hepatic resection of rectal metastatic disease.
abstract: BACKGROUND
  The objectives were to determine the feasibility of combined rectal and hepatic resections and analyze the disease-free survival and overall survival.
  
  
  METHODS
  Sixty patients who underwent resection for metastatic rectal disease from 1991 to 2005 at Mayo Clinic were reviewed. Inclusion criteria were: rectal cancer with metastatic liver disease and resectability of metastases. The exclusion criteria were: metachronous resection (n = 15). Kaplan-Meier Survival estimated overall survival (OS) and disease-free survival (DFS). Cox proportional hazard models examined the association between groups and survival.
  
  
  RESULTS
  The cohort comprised 22 men and 23 women, with median age of 63 years. Surgical management included: abdominoperineal resection, 13 patients (29%); low anterior resection, 29 (64%); local excision, one; total proctocolectomy, one; and pelvic exenteration, one. Major hepatic resection was performed in 22%. There was no mortality, but there were 26 postoperative complications. Disease-free survival from local recurrence at 1, 2, and 5 years was 92%, 86%, and 80%, respectively. Disease-free survival from distant recurrence at 1, 2, and 5 years was 62%, 43%, and 28%, respectively. Overall survival at 1, 2 and 5 years was 88%, 72%, and 32%, respectively.
  
  
  CONCLUSIONS
  Combined rectal and hepatic resection is safe. Morbidity and mortality do not preclude concurrent resection. The DFS and OS are comparable to that of patients undergoing a staged procedure.
authors: Division of Gastroenterologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors: Sarah York
authors: SY
authors: Boostrom
authors: Liana Tsikitis
authors: LT
authors: Vassiliki
authors: David M
authors: DM
authors: Nagorney
authors: Bruce G
authors: BG
authors: Wolff
authors: Heidi K
authors: HK
authors: Chua
authors: Scott
authors: S
authors: Harmsen
authors: David W
authors: DW
authors: Larson
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors