title: The interval approach: an adaptation of the liver-first approach to treat synchronous liver metastases from rectal cancer.
abstract: BACKGROUND
  The waiting interval after chemoradiotherapy (CRT) is an interesting therapeutic window to treat patients with synchronous liver metastases (SLM) from rectal cancer.
  
  
  METHODS
  A retrospective analysis was performed of 18 consecutive patients (M/F 10/8, age (range) 60 (51-75) years) from five institutions who underwent liver resection of SLM during the waiting interval after CRT for rectal adenocarcinoma.
  
  
  RESULTS
  All patients underwent interval liver surgery for a median (range) of 4 (2-14) liver metastases. Metastases involved a median (range) of 4 (1-7) liver segments. Median (range) time between end of CRT and liver surgery was 22 (6-45) days. Laparoscopic liver surgery was performed in 12 (67%) patients. No severe complications (Clavien-Dindo ≥ 3b) occurred after liver surgery. Median (range) length of hospital stay after liver surgery was 5 (1-10) days. All patients subsequently underwent rectal resection at a median (range) of 10 (8-13) weeks after end of CRT. Median (IQR) time-to-progression after liver surgery was 4.2 (2.8-9.2) months.
  
  
  CONCLUSIONS
  The waiting interval after neoadjuvant CRT is a valuable option to treat SLM from rectal cancer. More data are necessary to confirm its oncological efficacy.
authors.affiliation: Department of Abdominal Surgery, AZ Groeninge, Kortrijk, Belgium.
authors.forename: Mathieu
authors.initials: M
authors.lastname: D'Hondt
authors.affiliation: Department of Abdominal Surgery, Hôpital Erasme, Brussels, Belgium.
authors.forename: Valerio
authors.initials: V
authors.lastname: Lucidi
authors.affiliation: Department of Abdominal Surgery, AZ Imelda, Bonheiden, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Vermeiren
authors.affiliation: Department of Abdominal Surgery, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Van Den Bossche
authors.affiliation: Department of Abdominal Surgery, Hôpital Erasme, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Donckier
authors.affiliation: Department of Abdominal Surgery, Jessa Ziekenhuis, Salvatorstraat 20, B-3500, Hasselt, Belgium. Gregory.Sergeant@jessazh.be.|Faculty of Medicine and Life Sciences, UHasselt, Hasselt, Belgium. Gregory.Sergeant@jessazh.be.
authors.forename: Gregory
authors.identifier: http://orcid.org/0000-0001-8846-3824
authors.initials: G
authors.lastname: Sergeant
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Delayed approach; Interval approach; Liver resection; Rectal cancer; Simultaneous approach; Synchronous liver metastasis