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LONG-TERM SURVIVAL IS ACHIEVABLE AFTER COMPLEX SIMULTANEOUS RESECTION OF RECTAL CANCER WITH LIVER METASTASES
Kevin Labadie
*, Kelly Mahuron, Kristofor Olson, Darrell Fan, Peter Vien, Elizabeth Meshkin, Paul Wong, Kurt Melstrom, Aaron Lewis, Yasmin Zerhouni, Bradford Kim, Mark Hanna, Lily L. Lai, Andreas M. Kaiser, Yuman Fong, Laleh G. Melstrom
City of Hope Department of Surgery, Duarte, CA
Synchronous liver metastases are present in approximately 15% of patients diagnosed with colorectal cancer. Simultaneous resection remains controversial in patients with rectal cancer and liver metastasis (RCLM). Long-term oncologic outcomes after simultaneous resection for RCLM have not been widely reported and is the objective of this study.
A single-center, retrospective analysis of patients who underwent curative-intent, simultaneous rectal resection and hepatectomy for metastatic rectal adenocarcinoma between 2011 and May 2024 was conducted. Rectal primary tumors were within 16 cm of the anal verge on flexible sigmoidoscopy. Overall survival (OS) was measured from the time of surgery to death from any cause. Recurrence-free survival (RFS) and hepatic-recurrence free survival (H-RFS) were measured from time of surgery to radiographic recurrence in any site or in the liver, respectively. Cox regression analyses were performed to assess impact of clinicopathologic variables .
92 patients underwent simultaneous resection. The burden of hepatic metastases and risk for hepatic recurrence was elevated in our cohort with an increased Clinical Risk Score (median 4, 91% CRS of 3, 4, or 5) and Tumor Burden Score (59% Zone 2, 21% Zone 3). 99% of patients received neoadjuvant systemic therapy (median 6 cycles, IQR 3-10) and 48% received neoadjuvant pelvic chemoradiation. 8 patients had extrahepatic metastases at time of surgery (9%). Most patients underwent LAR (n=81, 88%) with diverting ostomy (n=50, 57%). Complex hepatectomy was mostly performed (Kawaguchi Hepatectomy Grade 3 = 49%, n = 45) including non-anatomic hepatic resections (65%, n=61). Nineteen patients underwent major hepatectomy (21%). A hepatic arterial infusion pump (HAIP) was placed in 21 patients (23%). R1 hepatic resection occurred in 13 patients (14%). No deaths occurred within 90 days. 80% of patients returned to intended oncologic therapy by 3 months, at a median of 6 weeks post-operatively (IQR 3.7-9.7weeks)
The median follow up was 51 months. The median OS from resection was 70 months, 75 months from initial diagnosis, and the 5-year OS was 54%. Median RFS was 10 months and 5-year RFS was 10%. Median H-RFS was 17 months, and 5-year H-RFS was 33%. Pelvic recurrence occurred in 11 patients (12%) at a median of 8.4mo postoperatively (range 3-15mo). Univariate Cox proportional hazard regression is shown in Table 1. Positive hepatic margin was associated with reduced OS, while high clinical risk score and high tumor burden category was associated with reduced RFS and H-RFS but did not impact OS.
In patients with elevated hepatic tumor burden, complex simultaneous resection conferred long-term survival. Elevated hepatic burden was associated with reduced RFS and H-RFS but was not associated with OS. Simultaneous resection can be reasonably offered for management of high-risk synchronous RCLM.
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