Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France.
Department of Radiology, Institut Paoli Calmettes, Marseille, France.
World J Surg Oncol. 2023 Mar 3;21(1):75. doi: 10.1186/s12957-023-02946-6.
The optimal management of rectal cancer with synchronous liver metastases remains debatable. Thus, we propose an optimised liver-first (OLF) strategy that combines concomitant pelvic irradiation with hepatic management. This study aimed to evaluate the feasibility and oncological quality of the OLF strategy.
Patients underwent systemic neoadjuvant chemotherapy followed by preoperative radiotherapy. Liver resection was performed in one step (between radiotherapy and rectal surgery) or in two steps (before and after radiotherapy). The data were collected prospectively and analysed retrospectively as intent to treat.
Between 2008 and 2018, 24 patients underwent the OLF strategy. The rate of treatment completion was 87.5%. Three patients (12.5%) did not proceed to the planned second-stage liver and rectal surgery because of progressive disease. The postoperative mortality rate was 0%, and the overall morbidity rates after liver and rectal surgeries were 21% and 28.6%, respectively. Only two patients developed severe complications. Liver and rectal complete resection was performed in 100% and 84.6%, respectively. A rectal-sparing strategy was performed in 6 patients who underwent local excision (n = 4) or a watch and wait strategy (n = 2). Among patients who completed treatment, the median overall and disease-free survivals were 60 months (range 12-139 months) and 40 months (range 10-139 months), respectively. Eleven patients (47.6%) developed recurrence, among whom five underwent further treatment with curative intent.
The OLF approach is feasible, relevant, and safe. Organ preservation was feasible for a quarter of patients and may be associated with reduced morbidity.
同步肝转移直肠癌的最佳治疗方法仍存在争议。因此，我们提出了一种联合盆腔放疗和肝脏管理的优化肝优先（OLF）策略。本研究旨在评估 OLF 策略的可行性和肿瘤学质量。
患者接受全身新辅助化疗，然后进行术前放疗。肝切除术可一步完成（在放疗和直肠手术之间）或分两步完成（在放疗前后）。数据前瞻性收集并进行意向治疗的回顾性分析。
2008 年至 2018 年期间，24 例患者接受了 OLF 策略。治疗完成率为 87.5%。由于疾病进展，有 3 例患者（12.5%）未进行计划中的第二阶段肝和直肠手术。术后死亡率为 0%，肝和直肠手术后总发病率分别为 21%和 28.6%。仅 2 例患者发生严重并发症。肝和直肠完全切除率分别为 100%和 84.6%。6 例患者（4 例行局部切除，2 例观察等待）采用直肠保留策略。在完成治疗的患者中，中位总生存和无病生存时间分别为 60 个月（范围 12-139 个月）和 40 个月（范围 10-139 个月）。11 例（47.6%）患者复发，其中 5 例患者接受了进一步的治愈性治疗。
OLF 方法是可行的、相关的和安全的。四分之一的患者可行器官保留，并且可能与降低发病率有关。
