摘要
BACKGROUND Rectal sparing is an option for some rectal cancers with complete or good response after chemoradiotherapy(CRT);however,it has never been evaluated in patients with metastases.We assessed long-term outcomes of a rectal-sparing approach in a liver-first strategy for patients with rectal cancer with resectable liver metastases.CASE SUMMARY We examined patients who underwent an organ-sparing approach for rectal cancer with synchronous liver metastases using a liver-first strategy during 2010-2015(n=8).Patients received primary chemotherapy and pelvic CRT.Liver surgery was performed during the interval between CRT completion and rectal tumor re-evaluation.Clinical and oncological characteristics and long-term outcomes were assessed.CASE SUMMARY All patients underwent liver metastatic resection with curative intent.The R0 rate was 100%.Six and two patients underwent local excision and a watch-and-wait(WW)approach,respectively.All patients had T3N1 tumors at diagnosis and had good clinical response after CRT.The median survival time was 60(range,14-127)mo.Three patients were disease free for 5,8,and 10 years after the procedure.Five patients developed metastatic recurrence in the liver(n=5)and/or lungs(n=2).Only one patient developed local recurrence concurrent with metastatic recurrence 24 mo after the WW approach.Two patients died during follow-up.CONCLUSION The results suggest good local control in patients undergoing organ-sparing strategies for rectal cancer with synchronous liver metastasis.Prospective trials are required to validate these data and identify good candidates for these strategies.
