Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer

Contemporary Surgical Management of Colorectal Liver Metastases

“…The LF approach was initially conceived to avoid issues associated with primary tumor resection that may result in a delay of chemotherapy administration, particularly in borderline resectable metastases [ 53 ]. In the first paper describing this approach, Mentha et al, examined 20 patients between 1999 and 2005 with synchronous CRLM.…”

“…In this way, the LF approach also allows for patients to be eligible for watch-and-wait in the setting of a complete clinical response for the primary, thereby completely avoiding primary resection morbidity; note, however, that the watch-and-wait method was studied in localized rectal tumors without metastasis [ 62 ]. Nonetheless, the theoretical benefit does exist, as the recent literature has noted a complete pathologic response in the primary rectal tumor in 6% of patients who underwent the LF approach [ 53 ]. Indeed, recent consensus recommendations have recognized the LF approach as a viable treatment strategy, particularly for rectal primaries or in patients with borderline resectable hepatic disease [ 63 ].…”

“…There are some notable issues with the LF approach that should be highlighted, however. A notable percentage of patients who undergo the LF approach do not proceed to primary tumor resection, which is associated with a significant decrease in OS; in a recent article by Maki et al, the most common cause of failure to resect the primary in the LF approach was disease progression following hepatectomy (76%) [ 53 ].…”