Journal Review in Hepatobiliary Surgery: Treatment Sequencing for Synchronous Liver Metastasis from Rectal Cancer

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 13 January 2025

⏱️ 24 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Among patients with colorectal cancer and synchronous liver metastases, the subgroup with a primary cancer in the rectum is especially challenging. Compared with colon cancer, most patients with stage IV rectal cancer will have locally advanced primary tumors at increased risk for obstructive and/or post-operative complications resulting in delays in systemic therapy. In this episode from the HPB team at Behind the Knife, listen in on the discussion about treatment sequencing for synchronous liver metastasis from rectal cancer

Hosts
Anish J. Jain MD (@anishjayjain) is a current PGY3 General Surgery Resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.

Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.

Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center.

Learning Objectives
· Develop an understanding of the three treatment sequences for resection of disease in patients with synchronous liver metastasis from a primary rectal cancer (reverse, combined, and classic approach)
· Develop an understanding of the benefits, risks, and nuances of each of the three treatment sequences
· Develop an understanding of which patient cases each treatment sequence is ideal for as well as which cases they are not suitable for.

Papers Referenced (in the order they were mentioned in the episode):
1) Conrad C, Vauthey JN, Masayuki O, et al. Individualized Treatment Sequencing Selection Contributes to Optimized Survival in Patients with Rectal Cancer and Synchronous Liver Metastases. Ann Surg Oncol. 2017 Dec;24(13):3857-3864.
https://pubmed.ncbi.nlm.nih.gov/28929463/

2) Maki H, Ayabe RI, Nishioka Y, et al. Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer. Ann Surg Oncol. 2023 Sep;30(9):5390-5400. doi: 10.1245/s10434-023-13656-4. Epub 2023 Jun 7. Erratum in: Ann Surg Oncol. 2023 Sep;30(9):5405.
https://pubmed.ncbi.nlm.nih.gov/37285096/

Additional Suggested Reading
Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary. Br J Surg. 2006 Jul;93(7):872-8.
https://pubmed.ncbi.nlm.nih.gov/16671066/

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Transcript

Click on a timestamp to play from that location

0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day. Greetings, everyone.
0:23.5	Welcome to another HVEV episode on Behind the Knife.
0:26.2	This is your HBB team at the MD Anderson Cancer Center in Houston.
0:29.8	I'm a niche, a general surgery resident at Stanford and a former T-32 fellow at MD Anderson.
0:35.4	I'm excited to be joined again by my mentor is Dr. Tim Newhook,
0:38.5	the associate PD of the HB Fellowship at MD Anderson, and Dr. Jean Nicholas Vote,
0:43.4	the HVB section chief at MD Anderson. Today, we're going to be discussing the treatment
0:47.9	sequencing options for patients with synchronous liver metastasis from rectocancer.
0:52.3	Additionally, we'll review a few articles investigating the use
0:55.8	of these approaches in the management of patients with synchronous liver metastasis. So just to start,
1:03.2	you know, amongst patients with colorectal cancer who have synchronous liver metastasis, the subgroup
1:08.0	who have a primary cancer in the rectum, it's especially challenging compared to
1:12.0	right or left colon cancer. Most of these patients would stage four rectal cancer have a locally
1:17.1	advanced primary tumor that's at risk for local complications that could require pelvic
1:22.0	radiation, resection, diversion, and they have a higher risk of anastomotic complications that can lead to delays
1:28.7	in systemic therapy, making it extremely challenging for these patients. So right now there's
1:33.7	three sequencing approaches to treat these patients who have the synchronous liver metastis
1:39.5	in addition to their rectal cancer. Dr. Newhook, do you think you could just talk about these
1:43.7	three approaches,
1:44.9	the classic combined and reverse approach? Yeah, sure. Thanks again for another great episode.
1:49.8	Anish, it's good to be to here again. Obviously, patients who have synchronous disease,
1:55.4	there's two sites of disease, both obviously the primary tumor as well as liver metastasities.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Behind The Knife: The Surgery Podcast, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Behind The Knife: The Surgery Podcast and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.