15-20% of patients with rectal cancer have synchronous liver metastases at presentation. There is limited evidence about the outcome for those with advanced rectal cancer who undergo pelvic exenteration and simultaneous liver resection.
Data from twenty international institutions that performed simultaneous pelvic exenteration and liver resection between 2007-2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival.
Of 128 patients, 72(56.2%) were male with a median age of 60(IQR15) years. The median size of the liver oligo-metastatic deposits was 2cm (IQR1.8). Median(range) duration of surgery was 406(IQR 240) minutes, with a median blood loss of 1090 mls(IQR 2010 mls). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major post-operative complication. The five-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection(p=0.006).
Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
International Collaboration; Liver metastasis; Rectal Cancer; Surgical Outcomes; Survival Outcomes