METHODS: This study is a retrospective review of a prospectively maintained surgical registry of all consecutive adult patients who underwent curative-intent resection at Mayo Clinic in Rochester, MN, from January 1990 until December 2014 with a median follow-up time of 43 (IQR 16-67) months. Eligible patients had locally-advanced
rectal cancer (T3, T4 and/or nodal involvement) with synchronous resectable liver and/or lung
metastasis. Exclusion criteria were as follows: patients with primary
tumor stage of T1N0 or T2N0, patients with
metastasis to organs other than the liver or lung, patients who had palliative resection, patients who had non-surgical treatment of synchronous
metastasis (e.g.,
radiofrequency ablation), patients who received postoperative
radiotherapy, or absence of research authorization. Ninety three patients were included of which 47 received
neoadjuvant radiotherapy and 46 did not. All patients received
neoadjuvant chemotherapy +/-
radiotherapy followed by curative-intent surgery with
metastasectomy performed either simultaneously with resection of the primary
tumor or as a planned staged resection. The primary outcomes of this study are LR, distant
metastasis, overall and disease-specific survival (DSS).
RESULTS: LR was observed in 12 patients (26%) who did not receive
radiotherapy, while no LR developed in those who received
neoadjuvant radiotherapy, P<0.001. Univariate analysis showed that neither age, sex, ASA class, BMI,
tumor location, procedure performed, or
neoadjuvant chemotherapy were associated with subsequent LR. The 5-year overall survival (OS) rates were: 43.3% (95% CI: 30.1, 62.3) for no
radiotherapy vs. 58.3% (95% CI: 43.4, 78.2) with
radiotherapy.
CONCLUSIONS: