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Effect of Primary Rectal Tumor Site

Lia Assumpcao, MD; Michael A. Choti, MD, MBA; Ana Luiza Gleisner, MD; Richard D. Schulick, MD; Michael Swartz, MD; Joseph Herman, MD; Susan L. Gearhart, MD; Timothy M. Pawlik, MD, MPH

Arch Surg. 2008;143(8):743-749.

Hypothesis  Patients with rectal adenocarcinoma are at increased risk of locoregional recurrence compared with patients with colon cancer. This may affect the pattern of recurrence and survival rates following hepatic resection of liver metastases from rectal adenocarcinoma.

Design  Retrospective review of a prospectively collected cancer center database.

Patient and Methods  From April 1, 1984, to December 31, 2005, 582 patients with liver metastases from a primary colorectal adenocarcinoma underwent hepatic resection. Clinical and pathological factors were analyzed using Cox regression analyses and log-rank tests.

Results  Of 582 patients, 141 (24.2%) had liver metastases from a primary rectal tumor site. Treatment of the primary rectal tumor most frequently included chemoradiation therapy (59.6%) and low anterior resection (63.1%). Most rectal tumors were pathological stage T3/T4 (85.8%) and N1 (68.1%). Treatment directed at the hepatic metastases included resection only (81.5%), resection plus radiofrequency ablation (17.8%), or radiofrequency ablation only (0.7%). With a median follow-up time of 30.7 months, 80 of 141 patients (56.7%) developed recurrence; 23 patients (16.3%) developed recurrence in the pelvis. Of 23 patients with pelvic recurrence, 56.5% also developed recurrence in the liver. The 3- and 5-year survival rates for all patients were 62.4% and 36.4%, respectively. Of 80 patients who had a recurrence following hepatic metastectomy, 23 (28.8%) underwent another operation. Following repeat metastectomy, 3- and 5-year survival rates were 76.7% and 38.6%, respectively.

Conclusions  Following resection of hepatic rectal metastases, pelvic recurrence is relatively common, and most patients with pelvic recurrence will also develop recurrence in the liver. Surgery for recurrent disease following hepatic resection of rectal metastases is warranted among well-selected patients.

Author Affiliations: Departments of Surgery (Drs Assumpcao, Choti, Gleisner, Schulick, Gearhart, and Pawlik) and Radiation Oncology (Drs Swartz and Herman), The Johns Hopkins School of Medicine, Baltimore, Maryland.

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