Long-term Results of the "Liver First" Approach in Patients With Locally Advanced Rectal Cancer and Synchronous Liver Metastases

BACKGROUND: There are no reports available on the long-term outcome of patients with the "liver first" approach. OBJECTIVES: The aim of this study was to present the long-term results of the "liver first" approach in our center. DESIGN: This study is a retrospective analysis. SETTING: This study was conducted at a tertiary referral center. PATIENTS: Patients from May 2003 to March 2009 were included. INTERVENTIONS: Patients with locally advanced rectal cancer and synchronous liver metastases were first treated for their liver metastases. If the treatment was successful, patients underwent neoadjuvant chemoradiotherapy and surgery for the rectal cancer. If metastases could not be resected, resection of the rectal primary was not routinely performed. MAIN OUTCOME MEASURES: The primary outcome measured was long-term results of the "liver first" approach. RESULTS: Of the 42 patients included (median age, 61 years), all but one (98%) started with neoadjuvant chemotherapy. In total, 31 (74%) patients completed the "liver first" approach. In 11 patients, curative therapy was not possible because of unresectable metastases; in 10 of these patients (91%), the primary tumor was not resected. LIMITATIONS: This study was limited because it was a retrospective analysis without a control group. CONCLUSIONS: By applying the "liver first" approach, the majority of this group of patients (74%) could undergo curative treatment of both metastatic and primary disease in combination with optimal neoadjuvant therapy. This strategy may avoid unnecessary rectal surgery in patients with incurable metastatic disease. In this selected patient group, long-term survival may be achieved with a 5-year survival rate of 67%.