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Simultaneous Resection Is Associated With Long-Term Survival in Patients With High-Risk Synchronous Rectal Cancer

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Oncology
  • Hepatobiliary Surgery

Background:

  • Simultaneous resection of rectal cancer liver metastases (RCLM) is infrequently performed due to safety concerns and limited outcome data.
  • Rectal cancer with liver metastases presents a complex challenge for surgical management.

Purpose of the Study:

  • To evaluate the peri-operative safety and oncological outcomes of simultaneous rectal and hepatic resection for RCLM.
  • To assess the long-term survival and recurrence patterns following this combined surgical approach.

Main Methods:

  • Retrospective analysis of 92 patients undergoing curative-intent simultaneous total mesorectal excision (TME) and hepatectomy for RCLM.
  • Data collected from January 2011 to May 2024 at a single institution.
  • Evaluation of post-operative complications, overall survival (OS), recurrence-free survival (RFS), and hepatic recurrence-free survival (H-RFS).

Main Results:

  • No peri-operative deaths occurred in 92 patients.
  • 15% of patients experienced complications greater than Clavien-Dindo Grade 3.
  • Median follow-up was 51 months, with median OS of 70 months, RFS of 10 months, and H-RFS of 17 months.
  • Positive hepatic margins, high Clinical Risk Score, high Tumor Burden Score, and >6 cycles of neoadjuvant chemotherapy were associated with poorer survival outcomes.

Conclusions:

  • Simultaneous resection of RCLM is a safe procedure with favorable long-term survival in carefully selected high-risk patients.
  • This surgical approach can be considered a reasonable treatment option for RCLM in appropriate clinical settings.