title: Long-term results of the "liver first" approach in patients with locally advanced rectal cancer and synchronous liver metastases.
abstract: BACKGROUND
  There are no reports available on the long-term outcome of patients with the "liver first" approach.
  
  
  OBJECTIVE
  The aim of this study was to present the long-term results of the "liver first" approach in our center.
  
  
  METHODS
  This study is a retrospective analysis.
  
  
  METHODS
  This study was conducted at a tertiary referral center.
  
  
  METHODS
  Patients from May 2003 to March 2009 were included.
  
  
  METHODS
  Patients with locally advanced rectal cancer and synchronous liver metastases were first treated for their liver metastases. If the treatment was successful, patients underwent neoadjuvant chemoradiotherapy and surgery for the rectal cancer. If metastases could not be resected, resection of the rectal primary was not routinely performed.
  
  
  METHODS
  The primary outcome measured was long-term results of the "liver first" approach.
  
  
  RESULTS
  Of the 42 patients included (median age, 61 years), all but one (98%) started with neoadjuvant chemotherapy. In total, 31 (74%) patients completed the "liver first" approach. In 11 patients, curative therapy was not possible because of unresectable metastases; in 10 of these patients (91%), the primary tumor was not resected.
  
  
  CONCLUSIONS
  This study was limited because it was a retrospective analysis without a control group.
  
  
  CONCLUSIONS
  By applying the "liver first" approach, the majority of this group of patients (74%) could undergo curative treatment of both metastatic and primary disease in combination with optimal neoadjuvant therapy. This strategy may avoid unnecessary rectal surgery in patients with incurable metastatic disease. In this selected patient group, long-term survival may be achieved with a 5-year survival rate of 67%.
authors: Division of Surgical Oncology, Erasmus MC, Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
authors: Ninos
authors: N
authors: Ayez
authors: Jacobus W A
authors: JW
authors: Burger
authors: Anne E
authors: AE
authors: van der Pool
authors: Alexander M M
authors: AM
authors: Eggermont
authors: Dirk J
authors: DJ
authors: Grunhagen
authors: Johannes H W
authors: JH
authors: de Wilt
authors: Cornelis
authors: C
authors: Verhoef
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome