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Management of the Patient with Rectal Cancer Presenting with Synchronous Liver Metastasis

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Difficult Decisions in Colorectal Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

An estimated 39,610 new cases of rectal cancer (RC) are expected in the United States in 2015 [1]. Synchronous colorectal liver metastasis (SCRLM) occurs in 20 % of patients with locally advanced RC [2, 3]. Median overall survival (OS) for patients with SCRLM is 20–24 months without resection as opposed to 5-year OS of up to 50 % with R0 resection of metastatic disease [4]. Oncologic outcomes continue to improve with the development of new effective chemotherapy regimens and increased hepatectomy rates [5, 6]. Patients with SCRLM constitute a heterogeneous group with varying preoperative fitness, tumor biology, tumor resectability, and symptomatology related to the primary tumor. Potential cure is dependent on the ability to resect all disease, and requires a multidisciplinary approach. Locally advanced RC requires chemoradiation (CRT) with surgery, whereas SCRLM is initially addressed with chemotherapy. Surgery for symptomatic relief is reserved for select cases. The optimal sequence of multimodality treatment to address the primary tumor and associated metastatic disease is under active investigation.

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  1. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Shafik M. Sidani & Maher A. Abbas

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    Neil Hyman

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    Konstantin Umanskiy

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Sidani, S.M., Abbas, M.A. (2017). Management of the Patient with Rectal Cancer Presenting with Synchronous Liver Metastasis. In: Hyman, N., Umanskiy, K. (eds) Difficult Decisions in Colorectal Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-40223-9_20

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