Treatment Strategy for Rectal Cancer with Synchronous Metastasis: 65 Consecutive Italian Cases from the Bologna Multidisciplinary Rectal Cancer Group

Abstract

Background: Twenty percent of rectal cancer patients have synchronous distant metastasis at diagnosis. At present, the treatment strategy in this patient setting is not well defined. This study in one institution evaluates the treatment strategy of three different patient groups. Patients and Methods: Between January 2000 and July 2011, 65 patients with M1 rectal cancer were evaluated. Three different groups were defined: rectal cancer with resectable metastatic disease (group A); rectal cancer with potentially resectable metastatic disease (group B), and rectal cancer with unresectable metastatic disease (group C). Results: Group A included 11 patients (16.9%), group B 28 patients (43.1%) and group C 26 patients (40%). Forty-three (66.2%) patients underwent surgery for primary rectal cancer, and 30 (46.2%) patients for metastasis resection (23 liver, 4 lung and 3 ovary). Median overall survival (OS) by group was: 51 (5-86; group A), 32 (24-40; group B) and 16 (7-26; group C) months. Patients undergoing metastasis resection have higher median OS than unresected patients (44 vs. 15 months; p < 0.001). Conclusions: The treatment strategy in synchronous metastatic rectal cancer must consider the possibility of distant metastasis resection. Long-term survival can be achieved using an integrated approach.

Short-Course Radiotherapy Followed by Neoadjuvant Bevacizumab, Capecitabine, and Oxaliplatin and Subsequent Radical Treatment in Primary Stage IV Rectal Cancer: Long-Term Results of a Phase II Study

“… 10 In addition, patients with metastases in multiple organs, who were eligible for this study, have a worse progression-free survival. 11 The median overall survival of 3.8 years is longer than could be expected in patients with primary stage IV rectal cancer, 4 but is in accordance with other studies investigating neoadjuvant treatment before surgical resection of all tumor sites; 12 – 15 however, these studies had a retrospective design and only included patients with liver metastases.…”

“…Because resection of the primary tumor has no impact on overall survival as opposed to resection of the metastasis, and the metastases can potentially give rise to further systemic spread of the disease, the latter should not be delayed and a metastasis-first or simultaneous approach are preferable. 13 , 15 Furthermore, the complication rate of a simultaneous resection is not inferior to a staged resection, but total hospital stay is significantly shorter. 12 , 25 Both resection of the primary rectal tumor and resection of hepatic or extrahepatic rectal cancer metastases can cause significant morbidity; 26 , 27 therefore, radiological restaging after neoadjuvant therapy is important to make sure that all tumor locations are still resectable.…”

Case Report: Long-term survival of a patient with advanced rectal cancer and multiple pelvic recurrences after seven surgeries

“…The Japanese guidelines for the treatment of CRC recommend surgical treatment of the metastatic lesion if the patient can tolerate it and both the primary colorectal and metastatic lesions are completely resectable ( 7 ). According to the results of the Bologna Multidisciplinary Rectal Cancer Group, people who underwent metastatic resection had a longer OS ( 51 ).. However, the main problem with resection of liver metastases is the high recurrence rate, which is as high as 75% within 2 years and is the main cause of postoperative mortality in patients ( 52 ).…”