Rectal Cancer with Synchronous Liver Metastases: Leave It All in? When (not) to Resect the Primary?

摘要

Rectal cancer with synchronous distant metastases is challenging the choice of optimal treatment. Today, it is unknown if and when the primary tumor should or should not be resected. The current literature was reviewed. Data on the safety of a primary chemotherapy approach are reported. These publications indicate that at least in selected situations without severe symptoms or complications resulting from the primary, the rectum can be left in situ without major risks for the patient. However, retrospective analyses from randomized controlled trials indicate a potential prognostic advantage for patients having the primary tumor resected. The reason for this observation is largely unknown and requires further investigation. Due to the lack of data from prospective randomized controlled trials illuminating the situation of rectal cancer with synchronous distant metastases and due to the rapid changes evolving in the field of systemic treatment of metastatic colorectal cancer, no clear conclusions can be drawn at this stage. But a practical algorithm that may reflect current European treatment patterns is presented in this article.