PMID- 30554788
OWN - NLM
STAT- MEDLINE
DCOM- 20190417
LR  - 20190417
IS  - 1532-2157 (Electronic)
IS  - 0748-7983 (Linking)
VI  - 45
IP  - 4
DP  - 2019 Apr
TI  - The liver-first approach for locally advanced rectal cancer and synchronous liver
      metastases.
PG  - 591-596
LID - S0748-7983(18)32029-8 [pii]
LID - 10.1016/j.ejso.2018.12.007 [doi]
AB  - BACKGROUND: Patients with locally advanced rectal cancer (LARC) and synchronous
      liver metastases (sRLM) can be treated according to the liver-first approach.
      This study aimed to evaluate prognostic factors for completing treatment and in
      how many patients extensive lower pelvic surgery might have been omitted.
      METHODS: Retrospective analysis of all patients with LARC and sRLM treated at the
      Erasmus MC Cancer Institute according to the liver-first between 2003 and 2016.
      RESULTS: In total 129 consecutive patients were included. In 90 patients (70%)
      the liver-first was completed. Ten patients had a (near) complete response
      (ypT0-1N0) of their primary tumour. In 36 out of 39 patients not completing the
      liver-first protocol palliative rectum resection was withheld. Optimal cut-offs
      for CEA level (53.15mug/L), size (3.85cm) and number (4) of RLMs were identified.
      A preoperative CEA level above 53.15mug/L was an independent predictor for
      non-completion of the liver-first protocol (p=0.005). CONCLUSION: Ten patients
      had a (near) complete response of their primary tumour and, in retrospect, rectum
      sparing therapies could have been considered. Together with 36 patient in whom
      palliative rectum resection was not necessary this entails that nearly 40%
      patients with LARC and sRLM might be spared major pelvic surgery if the
      liver-first approach is applied. A predictor (CEA) was found for non-completion
      of the liver-first protocol. The majority of patients underwent resection of both
      primary tumour and hepatic metastasis with curative intent. These findings
      together entail that the liver-first approach may be considered in patients with 
      LARC and sRLM.
CI  - Copyright (c) 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and
      the European Society of Surgical Oncology. All rights reserved.
FAU - Nierop, P M H
AU  - Nierop PMH
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - Verseveld, M
AU  - Verseveld M
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands; Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam,
      the Netherlands.
FAU - Galjart, B
AU  - Galjart B
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - Rothbarth, J
AU  - Rothbarth J
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - Nuyttens, J J M E
AU  - Nuyttens JJME
AD  - Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - van Meerten, E
AU  - van Meerten E
AD  - Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - Burger, J W A
AU  - Burger JWA
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - Grunhagen, D J
AU  - Grunhagen DJ
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands.
FAU - Verhoef, C
AU  - Verhoef C
AD  - Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the
      Netherlands. Electronic address: c.verhoef@erasmusmc.nl.
LA  - eng
PT  - Journal Article
DEP - 20181210
PL  - England
TA  - Eur J Surg Oncol
JT  - European journal of surgical oncology : the journal of the European Society of
      Surgical Oncology and the British Association of Surgical Oncology
JID - 8504356
RN  - 0 (Carcinoembryonic Antigen)
SB  - IM
MH  - Aged
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - Carcinoembryonic Antigen/blood
MH  - Chemotherapy, Adjuvant
MH  - Disease Progression
MH  - Female
MH  - *Hepatectomy
MH  - Humans
MH  - Liver Neoplasms/blood/pathology/secondary/*therapy
MH  - Male
MH  - Middle Aged
MH  - Neoadjuvant Therapy
MH  - Palliative Care
MH  - Postoperative Complications/etiology
MH  - Preoperative Period
MH  - ROC Curve
MH  - Rectal Neoplasms/blood/pathology/*therapy
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Time Factors
MH  - Tumor Burden
EDAT- 2018/12/18 06:00
MHDA- 2019/04/18 06:00
CRDT- 2018/12/18 06:00
PHST- 2018/07/22 00:00 [received]
PHST- 2018/11/16 00:00 [revised]
PHST- 2018/12/08 00:00 [accepted]
PHST- 2018/12/18 06:00 [pubmed]
PHST- 2019/04/18 06:00 [medline]
PHST- 2018/12/18 06:00 [entrez]
AID - S0748-7983(18)32029-8 [pii]
AID - 10.1016/j.ejso.2018.12.007 [doi]
PST - ppublish
SO  - Eur J Surg Oncol. 2019 Apr;45(4):591-596. doi: 10.1016/j.ejso.2018.12.007. Epub
      2018 Dec 10.