Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2023; 15(11): 2619-2626
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2619
Organ sparing to cure stage IV rectal cancer: A case report and review of literature
Hélène Meillat, Jonathan Garnier, Anais Palen, Jacques Ewald, Cécile de Chaisemartin, Marguerite Tyran, Emmanuel Mitry, Bernard Lelong
Hélène Meillat, Jonathan Garnier, Anais Palen, Jacques Ewald, Cécile de Chaisemartin, Emmanuel Mitry, Bernard Lelong, Department of Digestive Surgical Oncology, Institut Paoli Calmettes, Marseille 13009, France
Marguerite Tyran, Department of Radiotherapy, Institut Paoli Calmettes, Marseille 13009, France
Author contributions: Meillat H, Lelong B, Ewald J, Mitry E study conception and design; Palen A, Garnier J, Tyran M acquisition of data; Meillat H, Garnier J analysis an interpretation of data; Meillat H, Palen A, Mitry E drafting of manuscript; de Chaisemartin C, Lelong B, Tyran M, Ewald J critical revision of manuscript; All authors have reviewed and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient and his parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hélène Meillat, MD, Surgeon, Surgical Oncologist, Department of Digestive Surgical Oncology, Institut Paoli Calmettes, No. 232 bd Sainte Marguerite, Marseille 13009, France. meillath@ipc.unicancer.fr
Received: June 13, 2023
Peer-review started: June 13, 2023
First decision: July 6, 2023
Revised: August 3, 2023
Accepted: August 28, 2023
Article in press: August 28, 2023
Published online: November 27, 2023
Abstract
BACKGROUND

Rectal sparing is an option for some rectal cancers with complete or good response after chemoradiotherapy (CRT); however, it has never been evaluated in patients with metastases. We assessed long-term outcomes of a rectal-sparing approach in a liver-first strategy for patients with rectal cancer with resectable liver metastases.

CASE SUMMARY

We examined patients who underwent an organ-sparing approach for rectal cancer with synchronous liver metastases using a liver-first strategy during 2010-2015 (n = 8). Patients received primary chemotherapy and pelvic CRT. Liver surgery was performed during the interval between CRT completion and rectal tumor re-evaluation. Clinical and oncological characteristics and long-term outcomes were assessed.

All patients underwent liver metastatic resection with curative intent. The R0 rate was 100%. Six and two patients underwent local excision and a watch-and-wait (WW) approach, respectively. All patients had T3N1 tumors at diagnosis and had good clinical response after CRT. The median survival time was 60 (range, 14-127) mo. Three patients were disease free for 5, 8, and 10 years after the procedure. Five patients developed metastatic recurrence in the liver (n = 5) and/or lungs (n = 2). Only one patient developed local recurrence concurrent with metastatic recurrence 24 mo after the WW approach. Two patients died during follow-up.

CONCLUSION

The results suggest good local control in patients undergoing organ-sparing strategies for rectal cancer with synchronous liver metastasis. Prospective trials are required to validate these data and identify good candidates for these strategies.

Keywords: Colorectal cancer, Liver metastasis, Rectal sparing, Pver-first strategy

Core Tip: Our liver first strategy allows long course randomized controlled trial achievement without compromising systemic treatment. In case of good response after chemoradiotherapy, rectal sparing has never been evaluated in patients with metastases. Rectal sparing strategy results in low morbidity and improved patient’s long-term quality of life. With a follow-up more than 5 years, we described a good local control in 8 patients with metastases. Prospective trials are required to validate these data and identify good candidates for these strategies.