title: Neoadjuvant chemotherapy and primary-first approach for rectal cancer with synchronous liver metastases.
abstract: OBJECTIVE
  Up to a quarter of patients with rectal cancer have synchronous liver metastases at the time of diagnosis. This is a predictor of poor outcome. There are no standardized guidelines for treatment. We reviewed the outcomes of our patients with synchronous rectal liver metastases treated with a curative intent by neoadjuvant chemotherapy with or without chemoradiotherapy followed by resection of the primary tumour and then liver metastases.
  
  
  METHODS
  Between 2004 and 2012, patients who presented with rectal cancer and synchronous liver metastasis were treated with curative intent with peri-operative systemic chemotherapy as the first line of treatment. Responders to chemotherapy underwent resection of the primary tumour with or without preoperative chemoradiotherapy followed by hepatic resection.
  
  
  RESULTS
  Fifty-three rectal cancer patients with 152 synchronous liver lesions were identified. After a median follow-up of 29.6 months, the median survival was 41.4 months. Overall survival was 59.0% at 3 years and 39.0% at 5 years.
  
  
  CONCLUSIONS
  Rectal resection before hepatic resection combined with neoadjuvant chemotherapy is associated with promising clinical outcome. It allows downstaging of liver lesions and removal of the primary tumour before the progression of further micrometastases. Furthermore, patients who do not respond to chemotherapy can be identified and may avoid major surgical intervention.
authors.affiliation: Department of Surgery and Cancer, HPB Surgical Unit, Hammersmith Hospital, Imperial College, London, UK.
authors.forename: T M H
authors.initials: TM
authors.lastname: Gall
authors.forename: M
authors.initials: M
authors.lastname: Basyouny
authors.forename: A E
authors.initials: AE
authors.lastname: Frampton
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.forename: P
authors.initials: P
authors.lastname: Ziprin
authors.forename: P
authors.initials: P
authors.lastname: Dawson
authors.forename: P
authors.initials: P
authors.lastname: Paraskeva
authors.forename: N A
authors.initials: NA
authors.lastname: Habib
authors.forename: D R C
authors.initials: DR
authors.lastname: Spalding
authors.forename: S
authors.initials: S
authors.lastname: Cleator
authors.forename: C
authors.initials: C
authors.lastname: Lowdell
authors.forename: L R
authors.initials: LR
authors.lastname: Jiao
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003082:Colectomy; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents
keywords: Rectal cancer; neoadjuvant; primary first; synchronous liver metastases