The liver-first approach for locally advanced rectal cancer and synchronous liver metastases.
Eur J Surg Oncol
; 45(4): 591-596, 2019 04.
Article
en En
| MEDLINE
| ID: mdl-30554788
ABSTRACT
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⯵g/L), size (3.85â¯cm) and number (4) of RLMs were identified. A preoperative CEA level above 53.15⯵g/L was an independent predictor for non-completion of the liver-first protocol (pâ¯=â¯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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Neoplasias del Recto
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Protocolos de Quimioterapia Combinada Antineoplásica
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Hepatectomía
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Neoplasias Hepáticas
Tipo de estudio:
Etiology_studies
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Guideline
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Eur J Surg Oncol
Asunto de la revista:
NEOPLASIAS
Año:
2019
Tipo del documento:
Article
País de afiliación:
Países Bajos