The liver-first approach for locally advanced rectal cancer and synchronous liver metastases.
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Carcinoembryonic Antigen
/ blood
Chemotherapy, Adjuvant
Disease Progression
Female
Hepatectomy
Humans
Liver Neoplasms
/ blood
Male
Middle Aged
Neoadjuvant Therapy
Palliative Care
Postoperative Complications
/ etiology
Preoperative Period
ROC Curve
Rectal Neoplasms
/ blood
Retrospective Studies
Survival Rate
Time Factors
Tumor Burden
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
22
07
2018
revised:
16
11
2018
accepted:
08
12
2018
pubmed:
18
12
2018
medline:
18
4
2019
entrez:
18
12
2018
Statut:
ppublish
Résumé
Patients with locally advanced rectal cancer (LARC) and synchronous liver metastases (sRLM) can be treated according to the liver-first approach. This study aimed to evaluate prognostic factors for completing treatment and in how many patients extensive lower pelvic surgery might have been omitted. Retrospective analysis of all patients with LARC and sRLM treated at the Erasmus MC Cancer Institute according to the liver-first between 2003 and 2016. In total 129 consecutive patients were included. In 90 patients (70%) the liver-first was completed. Ten patients had a (near) complete response (ypT0-1N0) of their primary tumour. In 36 out of 39 patients not completing the liver-first protocol palliative rectum resection was withheld. Optimal cut-offs for CEA level (53.15 μg/L), size (3.85 cm) and number (4) of RLMs were identified. A preoperative CEA level above 53.15 μg/L was an independent predictor for non-completion of the liver-first protocol (p = 0.005). Ten patients had a (near) complete response of their primary tumour and, in retrospect, rectum sparing therapies could have been considered. Together with 36 patient in whom palliative rectum resection was not necessary this entails that nearly 40% patients with LARC and sRLM might be spared major pelvic surgery if the liver-first approach is applied. A predictor (CEA) was found for non-completion of the liver-first protocol. The majority of patients underwent resection of both primary tumour and hepatic metastasis with curative intent. These findings together entail that the liver-first approach may be considered in patients with LARC and sRLM.
Sections du résumé
BACKGROUND
Patients with locally advanced rectal cancer (LARC) and synchronous liver metastases (sRLM) can be treated according to the liver-first approach. This study aimed to evaluate prognostic factors for completing treatment and in how many patients extensive lower pelvic surgery might have been omitted.
METHODS
Retrospective analysis of all patients with LARC and sRLM treated at the Erasmus MC Cancer Institute according to the liver-first between 2003 and 2016.
RESULTS
In total 129 consecutive patients were included. In 90 patients (70%) the liver-first was completed. Ten patients had a (near) complete response (ypT0-1N0) of their primary tumour. In 36 out of 39 patients not completing the liver-first protocol palliative rectum resection was withheld. Optimal cut-offs for CEA level (53.15 μg/L), size (3.85 cm) and number (4) of RLMs were identified. A preoperative CEA level above 53.15 μg/L was an independent predictor for non-completion of the liver-first protocol (p = 0.005).
CONCLUSION
Ten patients had a (near) complete response of their primary tumour and, in retrospect, rectum sparing therapies could have been considered. Together with 36 patient in whom palliative rectum resection was not necessary this entails that nearly 40% patients with LARC and sRLM might be spared major pelvic surgery if the liver-first approach is applied. A predictor (CEA) was found for non-completion of the liver-first protocol. The majority of patients underwent resection of both primary tumour and hepatic metastasis with curative intent. These findings together entail that the liver-first approach may be considered in patients with LARC and sRLM.
Identifiants
pubmed: 30554788
pii: S0748-7983(18)32029-8
doi: 10.1016/j.ejso.2018.12.007
pii:
doi:
Substances chimiques
Carcinoembryonic Antigen
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
591-596Informations de copyright
Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.