Reverse Approach as Preferred Strategy for Synchronous Rectal Cancer withLiver Metastases Travel Award

Background: Improved outcomes has led to aggressive surgical management for patients with synchronous rectal cancer with liver metastases (LM), but consensus on surgical sequencing is lacking. We sought to evaluate outcomes between reverse-, classic-, and combined-approaches.
Methods: Prospectively-maintained databases were queried for patients with LM diagnosed before primary resection and underwent hepatectomy for LM (1/2004-4/2021). Clinicopathological factors and survival were compared between 3 strategies.
Results: Among 274 patients, most underwent reverse-approach (51%), compared to 27% classic-approach, and 22% combined-approach. Characteristics of more complex disease, such as tumors ≤ 10 cm from anal verge, higher CEA at LM diagnosis, and increasing number of LM were associated with reverse-approach. Combined-approach patients had smaller tumors and underwent less major hepatectomies. Prehepatectomy chemotherapy cycles ≥ 8, initial CEA, and LM size were independently associated with OS (all p≤0.002). Despite 35% of reverse-approach not undergoing primary resection, there was no difference in OS between groups and 82% of these patients did not require diversion during follow-up.
Conclusion: For patients with more complex LM, reverse-approach results in similar survival as combined and classic-approaches and may avoid primary rectal resections that do not impact outcomes.