• Colorectal liver metastasis
• Hepatectomy
• Metachronous
• Recurrence
• Survival
• Synchronous

• Humans
• Male
• Hepatectomy/methods
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Female
• Aged
• Colorectal Neoplasms/pathology
• Neoplasm Recurrence, Local/epidemiology
• Middle Aged
• Survival Rate
• Neoadjuvant Therapy
• Reoperation
• Chemotherapy, Adjuvant
• Neoplasms, Second Primary
• Neoplasms, Multiple Primary

• colorectal neoplasms
• neoplasm metastasis
• liver neoplasms
• liver surgery
• hepatectomy

• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Colorectal Neoplasms/pathology
• Neoadjuvant Therapy
• Hepatectomy/methods
• Treatment Outcome

• hepatectomy
• liver
• liver transplantation
• metastasis
• neoadjuvant therapy

• colorectal cancer
• disease-free survival
• liver metastases
• liver-first approach

Colorectal cancer is the third most common cancer in France and by the time of the diagnosis, 15–25% of patients will suffer from synchronous liver metastases. Surgery associated to neoadjuvant treatment can cure these patients, but few studies focus only on rectal cancer. This study was meant to compare the outcomes of patients who underwent a simultaneous resection to those who underwent a staged resection (rectum first or liver first) in the University Hospital of Tours, France.

We assessed retrospectively a prospective maintained data base about the clinical, pathological and survival outcomes of patients who underwent a simultaneous or a staged resection in our center between 2010 and 2018. A propensity score matching was used, considering the initial characteristics of our groups.

There were 70 patients (55/15 males, female respectively) with median age 60 (54–68) years. After matching 48 (69%) of them underwent a staged approach and 22 (31%) a simultaneous approach were compared. After PSM, there were 22 patients in each group. No differences were found in terms of morbidity (p = 0.210), overall survival (p = 0.517) and disease-free survival (p = 0.691) at 3 years after matching. There were significantly less recurrences in the simultaneous group (50% vs 81.8%, p = 0.026).

Simultaneous resection of the rectal primary cancer and synchronous liver metastases is safe and feasible with no difference in terms of survival.

The online version contains supplementary material available at 10.1186/s12876-022-02250-9.

• Rectal cancer
• Simultaneous resection
• Staged resection
• Synchronous liver metastasis

• liver resection
• rectal cancer
• simultaneous rectal and liver surgery
• synchronous liver metastases
• textbook outcome

• Synchronous liver metastases
• causes of non-completion
• colorectal cancer
• completion
• liver-first
• survival

• Abdomen
• Colorectal Neoplasms/surgery
• Hepatectomy
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Retrospective Studies
• Treatment Outcome

• colorectal cancer
• liver synchronous metastasis
• one stage treatment
• outcomes
• simultaneous laparoscopic resection
• timing

• Liver metastases
• Neoadjuvant chemoradiation
• Rectal cancer
• Stage IV

• Colorectal cancer
• ablation
• liver metastasis
• resection
• simultaneous treatment

• Colorectal cancer
• Liver metastasis
• Metachronous
• Neoadjuvant chemotherapy
• Survival
• Synchronous

• Bowel-first approach
• Colorectal cancer
• Liver-first approach
• Meta-analysis
• Reversed approach
• Synchronous liver metastases

• Antineoplastic Agents/therapeutic use
• Chemotherapy, Adjuvant/statistics & numerical data
• Colectomy/adverse effects
• Colectomy/mortality
• Colonic Neoplasms/pathology
• Colonic Neoplasms/surgery
• Disease-Free Survival
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Liver Neoplasms/drug therapy
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Neoadjuvant Therapy/statistics & numerical data
• Neoplasm Staging
• Network Meta-Analysis
• Patient Dropouts/statistics & numerical data
• Postoperative Complications/etiology
• Proctectomy/adverse effects
• Proctectomy/mortality
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Survival Rate
• Time Factors

• Colorectal liver metastases
• Liver surgery
• Liver-first
• Neoadjuvant chemotherapy
• Reverse treatment

Although R0 surgery is recommended for stage IV colorectal cancer, the degree of required lymphadenectomy has not been established. The aim of this study was to investigate the prognostic impact of high ligation (HL) of the feeding artery and the number of retrieved lymph nodes after R0 surgery for colorectal cancer and synchronous colorectal cancer liver metastasis (CRLM).

This was a multi‐institutional retrospective analysis of patients with colorectal cancer and synchronous CRLM who had R0 surgery between January 1997 and December 2007. Clinical and pathological features were compared in patients who underwent HL and those who had a low ligation (LL). Kaplan–Meier analysis was performed to estimate the effect of HL on overall survival (OS). The impact of several risk factors on survival was analysed using the Cox proportional hazards model.

Of 549 patients, 409 (74·5 per cent) had HL. Median follow‐up was 51·4 months. HL significantly improved the 5‐year OS rate (58·2 per cent versus 49·3 per cent for LL; P = 0·017). Multivariable analysis revealed HL to be a significant prognostic factor compared with LL (5‐year mortality: hazard ratio (HR) 0·68, 95 per cent c.i. 0·51 to 0·90; P = 0·007). In subgroup analysis, the positive effect of HL on OS was greatest in patients with lymph node metastasis.

HL of the feeding artery was associated with improved OS in patients with colorectal cancer and synchronous CRLM after R0 surgery.

• Colorectal liver metastases
• Combined strategy
• CyberKnife
• Liver resection
• Oligometastases
• Stereotactic body radiotherapy
• Survival

• Aged
• Carcinoma/mortality
• Carcinoma/secondary
• Carcinoma/surgery
• Cohort Studies
• Colorectal Neoplasms/pathology
• Feasibility Studies
• Female
• Hepatectomy/methods
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Radiosurgery/methods
• Retrospective Studies
• Survival Rate
• Treatment Outcome

• Metastases
• Prognostic factor
• Rectal cancer
• Stage IV

• associating liver partition and portal vein ligation for staged hepatectomy
• colorectal liver metastases
• future liver remnant
• oncological outcome
• two-stage hepatectomy

• liver metastases colorectal cancer
• metastatic colorectal cancer
• peritoneal metastases colorectal cancer

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemoradiotherapy, Adjuvant
• Colectomy/adverse effects
• Colectomy/mortality
• Colorectal Neoplasms/diagnostic imaging
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Databases, Factual
• Female
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Netherlands
• Retrospective Studies
• Risk Factors
• Time Factors
• Time-to-Treatment
• Treatment Outcome

• Liver first
• Oncological outcomes
• Radiological response
• Tumor regression grade score (TRG)

• Aged
• Antineoplastic Agents, Immunological/therapeutic use
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Bevacizumab/therapeutic use
• Camptothecin/analogs & derivatives
• Camptothecin/therapeutic use
• Cetuximab/therapeutic use
• Cohort Studies
• Colectomy
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Disease-Free Survival
• Female
• Fluorouracil/therapeutic use
• Hepatectomy
• Humans
• Leucovorin/therapeutic use
• Liver Neoplasms/drug therapy
• Liver Neoplasms/secondary
• Male
• Margins of Excision
• Metastasectomy
• Middle Aged
• Neoadjuvant Therapy/methods
• Organoplatinum Compounds/therapeutic use
• Radiotherapy/methods
• Response Evaluation Criteria in Solid Tumors
• Survival Rate
• Treatment Outcome

In patients with resectable synchronous colorectal liver metastases (CRLM), either two-staged or simultaneous resections of the primary tumor and liver metastases are performed. Data on radiofrequency ablation (RFA) for the treatment of CRLM during a simultaneous procedure is lacking. The primary aim was to analyze short-term and long-term outcome of RFA in simultaneous treatment. A secondary aim was to compare simultaneous resection with the colorectal-first approach.

Retrospective analysis of 241 patients with colorectal cancer and synchronous CRLM between 2000–2016. Median follow-up was 36.1 months (IQR 18.2–58.8 months). A multivariable analysis was performed to analyze the postoperative morbidity, using the comprehensive complication index. A propensity matched analysis was performed to compare survival rates.

In multivariable analysis, the best predictor of lower complication severity was treatment with RFA (p = 0.040). Higher complication rates were encountered in patients who underwent an abdominoperineal resection (p = 0.027) or age > 60 years (p = 0.022). The matched analysis showed comparable overall survival in RFA treated patients versus patients undergoing a liver resection with a five year overall survival of 39.4% and 37.5%, respectively (p = 0.782). In a second matched analysis, 5-year overall survival rates in simultaneously treated patients (43.8%) was comparable to patients undergoing the colorectal first approach (43.0%, p = 0.223).

RFA treatment of CRLM in simultaneous procedures is associated with a lower complication severity and non-inferior oncological outcome as compared to partial liver resection. RFA should be considered a useful alternative to liver resection.

• Clinical
• Colorectal cancer
• Preclinical
• Surgery
• Tumor growth
• liver metastasis

• Locally advanced rectal cancer
• liver-first approach
• synchronus colorectal liver metastases

The waiting interval after chemoradiotherapy (CRT) is an interesting therapeutic window to treat patients with synchronous liver metastases (SLM) from rectal cancer.

A retrospective analysis was performed of 18 consecutive patients (M/F 10/8, age (range) 60 (51–75) years) from five institutions who underwent liver resection of SLM during the waiting interval after CRT for rectal adenocarcinoma.

All patients underwent interval liver surgery for a median (range) of 4 (2–14) liver metastases. Metastases involved a median (range) of 4 (1–7) liver segments. Median (range) time between end of CRT and liver surgery was 22 (6–45) days. Laparoscopic liver surgery was performed in 12 (67%) patients. No severe complications (Clavien-Dindo ≥ 3b) occurred after liver surgery. Median (range) length of hospital stay after liver surgery was 5 (1–10) days. All patients subsequently underwent rectal resection at a median (range) of 10 (8–13) weeks after end of CRT. Median (IQR) time-to-progression after liver surgery was 4.2 (2.8–9.2) months.

The waiting interval after neoadjuvant CRT is a valuable option to treat SLM from rectal cancer. More data are necessary to confirm its oncological efficacy.

• Delayed approach
• Interval approach
• Liver resection
• Rectal cancer
• Simultaneous approach
• Synchronous liver metastasis

• comorbidity
• patient selection
• surgical outcomes

Rectal cancer is a common type of malignant tumor in China, and its incidence rate is rising year by year. Middle and low rectal cancer accounts for 70%-80% of all rectal cancer cases. The treatment concept requires not only radical resection of tumor, but also preservation of the anal and urogenital function, in order to improve the quality of life. Improved surgical technique requires laparoscopic minimally invasive surgery, to reduce trauma and shorten hospital stay. To improve the 5-year disease-free survival rate, correct treatment of distant metastases, especially liver metastases, is required. By improving the accuracy of preoperative staging of rectal cancer, applying neoadjuvant therapy, and following the principle of total mesorectal excision, patients can benefit in terms of increased resection rate, decreased operation complication incidence, increased sphincter preservation, decreased local recurrence and increased overall survival rate. With the development of medical technology, minimally invasive surgery for low rectal cancer has been developed rapidly. Surgical resection is the only curative method in the therapy of rectal cancer and liver metastases. However, there are still some doubts concerning what to resect first in cases of synchronous rectal cancer and liver metastases in order to achieve the best results. In this paper, we discuss new progress in the surgical treatment of low rectal cancer and rectal cancer liver metastases.

• Low rectal cancer
• Sphincter saving resection
• Neoadjuvant therapy
• Rectal liver metastases
• "Liver-first" approach

There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes.

• Colorectal cancer
• guidelines
• metastatic disease
• surgery

• colorectal cancer guidelines
• colorectal liver metastases
• liver-first strategy

AIM: To evaluate the feasibility and survival outcomes of a liver-first approach.

METHODS: Between January 2009 and April 2013, 18 synchronous colorectal liver metastases (sCRLMs) patients with a planned liver-first approach in the Hepatopancreatobiliary Surgery Department I of the Beijing Cancer Hospital were enrolled in this study. Clinical data, surgical outcomes, morbidity and mortality rates were collected. The feasibility and long-term outcomes of the approach were retrospectively analyzed.

RESULTS: Sixteen patients (88.9%) completed the treatment protocol for primary and liver tumors. The main reason for treatment failure was liver disease recurrence. The 1 and 3 year overall survival rates were 94.4% and 44.8%, respectively. The median survival time was 30 mo. The postoperative morbidity and mortality were 22.2% and 0%, respectively, following a hepatic resection, and were 18.8% and 0%, respectively, after a colorectal surgery.

CONCLUSION: The liver-first approach appeared to be feasible and safe. It can be performed with a comparable mortality and morbidity to the traditional treatment paradigm. This approach might offer a curative opportunity for sCRLM patients with a high liver disease burden.

• Liver metastases
• Resection
• Colorectal cancer
• Synchronous

• Adult
• Aged
• Chemoradiotherapy, Adjuvant
• Chemotherapy, Adjuvant
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Feasibility Studies
• Female
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Metastasectomy/adverse effects
• Metastasectomy/methods
• Metastasectomy/mortality
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Young Adult

Recently, there has been a change in the strategy of how synchronous colorectal hepatic metastases are attributed to the development of more valuable protocols of chemotherapy and radiotherapy for neoadjuvant treatment of colorectal neoplasms and their hepatic metastases. There is a consensus that patients with synchronous colorectal hepatic metastases have lower survival than those with metachronous colorectal hepatic metastases. Currently, controversy remains concerning the best approach is sequence in a patient with colorectal cancer and synchronous hepatic metastases resection. To obtain a better patient selection, the authors have suggested the initial realization of systemic chemotherapy in the circumstance of patients with colorectal tumor stage IV, since these patients have a systemic disease. The rationale behind this liver-first strategy is initially the control of synchronous hepatic metastases of colorectal carcinoma, which can optimize a potentially curative hepatic resection and longstanding survival. The liver-first strategy procedure is indicated for patients with colorectal hepatic metastases who require downstaging therapy to make a curative liver resection possible. Thus, the liver-first strategy is considered an option in cases of rectal carcinoma in the early stage and with limited or advanced synchronous colorectal hepatic metastases or in case of patients with asymptomatic colorectal carcinoma, but with extensive liver metastases. Patients undergoing systemic chemotherapy and with progression of neoplastic disease should not undergo hepatic resection, because it does not change the prognosis and may even make it worse. To date, there have been no randomized controlled trials on surgical approach of colorectal synchronous hepatic metastases, despite the relatively high number of available manuscripts on this subject. All of these published studies are observational, usually retrospective, and often non-comparative. The patient selection criteria for the liver-first strategy should be individualized, and the approach of these patients should be performed by a multidisciplinary team so its benefits will be fully realized.

• Colorectal neoplasms
• Neoplasm metastasis
• Liver neoplasms
• Liver/surgery
• Hepatectomy
• Drug therapy
• Survival
• Prognosis

AIM: To offer an up-to-date review of all available treatment strategies for patients with synchronous colorectal liver metastases (CLM).

METHODS: A comprehensive literature search was performed to identify articles related to the management of patients with synchronous CLM. A search of the electronic databases PubMed, MEDLINE, and Google Scholar was conducted in September 2014. The following search terms were used: synchronous colorectal liver metastases, surgery, stage IV colorectal cancer, liver-first approach, and up-front hepatectomy. These terms were employed in various combinations to maximize the search. Only articles written in English were included. Particular attention was devoted to studies and review articles that were published within the last six years (2009-2014). Additional searches of the cited references from primary articles were performed to further improve the review. The full texts of all relevant articles were accessed by two independent reviewers.

RESULTS: Poor long-term outcomes of patients with synchronous CLM managed by a traditional treatment strategy have led to questions about the timing and sequence of possible therapeutic interventions. Thus, alternative paradigms called reverse strategies have been proposed. Presently, there are four treatment strategies available: (1) primary first approach (or traditional approach) comprises resection of the primary colorectal tumor followed by chemotherapy; subsequent liver resection is performed 3-6 mo after colorectal resection (provided that CLM are still resectable); (2) simultaneous resection of the primary colorectal tumor and CLM during a single operation presents intriguing options for a highly select group of patients, which can be associated with significant postoperative morbidity; (3) liver-first (or chemotherapy-first) approach comprises preoperative chemotherapy (3-6 cycles) followed by liver resection, adjuvant chemotherapy, and resection of the primary colorectal tumor (it is best suited for patients with asymptomatic primary tumors and initially unresectable or marginally resectable CLM); and (4) up-front hepatectomy (or “true” liver-first approach) includes liver resection followed by adjuvant chemotherapy, colorectal resection, and adjuvant chemotherapy (strategy can be offered to patients with asymptomatic primary tumors and initially resectable CLM).

CONCLUSION: None of the aforementioned strategies appears inferior. It is necessary to establish individual treatment plans in multidisciplinary team meetings through careful appraisal of all strategies.

• Colorectal cancer
• Liver-first approach
• Reverse strategy
• Simultaneous resection
• Up-front hepatectomy

• Antineoplastic Agents/administration & dosage
• Antineoplastic Agents/adverse effects
• Carcinoma/mortality
• Carcinoma/secondary
• Carcinoma/therapy
• Chemotherapy, Adjuvant
• Colectomy/adverse effects
• Colectomy/mortality
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Drug Administration Schedule
• Hepatectomy/adverse effects
• Hepatectomy/mortality
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/therapy
• Neoadjuvant Therapy
• Neoplasm Staging
• Patient Selection
• Risk Factors
• Time Factors
• Treatment Outcome

• Treatment
• Diagnosis
• Rectal cancer
• Review
• Screening
• Staging
• Treatment