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Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases

(2019) JOURNAL OF SURGICAL ONCOLOGY. 120(3). p.415-422
Author
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Abstract
Background and Objectives: The optimal treatment sequence in stage IV rectal cancer (RC) with synchronous liver metastases (SLM) remains undefined. Here, we compared outcomes between patients treated with the bowel-first approach (BFA) or the liver-first approach (LFA). Methods: Consecutive patients diagnosed with stage IV RC with SLM and who underwent complete resection were included. Both groups were matched using propensity scores. Differences in postoperative outcome, local control, and long-term survival were studied. In addition, a decision analysis (DA) model was built using TreeAge Pro to define the approach that results in the highest treatment completion rate. Results: During a 12-year period, 52 patients were identified, 21 and 31 of whom underwent the BFA and the LFA, respectively. Twenty-eight patients were matched; patients treated with the BFA experienced a longer median OS (50.0 vs 33.0 months; P = .40) and higher 5-year OS (42.9% vs 28.6%). The DA defined the BFA to be superior when the failure threshold (ie, no R0 resection, treatment discontinuation regardless of cause) for colectomy is less than 28.6%. Conclusions: In stage IV rectal cancer with SLM, either the BFA or the LFA result in similar long-term outcomes. Treatment should be tailored according to clinicopathological variables.
Keywords
COLORECTAL-CANCER, DECISION-ANALYSIS, RESECTION, SURGERY, OXALIPLATIN, MULTICENTER, bowel-first approach, decision analysis, liver-first approach, reversed, approach, synchronous liver metastases

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MLA
Ghiasloo, Mohammad, et al. “Effect of Treatment Sequence on Survival in Stage IV Rectal Cancer with Synchronous and Potentially Resectable Liver Metastases.” JOURNAL OF SURGICAL ONCOLOGY, vol. 120, no. 3, 2019, pp. 415–22.
APA
Ghiasloo, M., Kahya, H., Van Langenhove, S., Grammens, J., Vierstraete, M., Berardi, G., … Ceelen, W. (2019). Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases. JOURNAL OF SURGICAL ONCOLOGY, 120(3), 415–422.
Chicago author-date
Ghiasloo, Mohammad, Hasan Kahya, Samuel Van Langenhove, Julien Grammens, Maaike Vierstraete, Giammauro Berardi, Roberto Troisi, and Wim Ceelen. 2019. “Effect of Treatment Sequence on Survival in Stage IV Rectal Cancer with Synchronous and Potentially Resectable Liver Metastases.” JOURNAL OF SURGICAL ONCOLOGY 120 (3): 415–22.
Chicago author-date (all authors)
Ghiasloo, Mohammad, Hasan Kahya, Samuel Van Langenhove, Julien Grammens, Maaike Vierstraete, Giammauro Berardi, Roberto Troisi, and Wim Ceelen. 2019. “Effect of Treatment Sequence on Survival in Stage IV Rectal Cancer with Synchronous and Potentially Resectable Liver Metastases.” JOURNAL OF SURGICAL ONCOLOGY 120 (3): 415–422.
Vancouver
1.
Ghiasloo M, Kahya H, Van Langenhove S, Grammens J, Vierstraete M, Berardi G, et al. Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases. JOURNAL OF SURGICAL ONCOLOGY. 2019;120(3):415–22.
IEEE
[1]
M. Ghiasloo et al., “Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases,” JOURNAL OF SURGICAL ONCOLOGY, vol. 120, no. 3, pp. 415–422, 2019.
@article{8634863,
  abstract     = {Background and Objectives: The optimal treatment sequence in stage IV rectal cancer (RC) with synchronous liver metastases (SLM) remains undefined. Here, we compared outcomes between patients treated with the bowel-first approach (BFA) or the liver-first approach (LFA).
Methods: Consecutive patients diagnosed with stage IV RC with SLM and who underwent complete resection were included. Both groups were matched using propensity scores. Differences in postoperative outcome, local control, and long-term survival were studied. In addition, a decision analysis (DA) model was built using TreeAge Pro to define the approach that results in the highest treatment completion rate.
Results: During a 12-year period, 52 patients were identified, 21 and 31 of whom underwent the BFA and the LFA, respectively. Twenty-eight patients were matched; patients treated with the BFA experienced a longer median OS (50.0 vs 33.0 months; P = .40) and higher 5-year OS (42.9% vs 28.6%). The DA defined the BFA to be superior when the failure threshold (ie, no R0 resection, treatment discontinuation regardless of cause) for colectomy is less than 28.6%.
Conclusions: In stage IV rectal cancer with SLM, either the BFA or the LFA result in similar long-term outcomes. Treatment should be tailored according to clinicopathological variables.},
  author       = {Ghiasloo, Mohammad and Kahya, Hasan and Van Langenhove, Samuel and Grammens, Julien and Vierstraete, Maaike and Berardi, Giammauro and Troisi, Roberto and Ceelen, Wim},
  issn         = {0022-4790},
  journal      = {JOURNAL OF SURGICAL ONCOLOGY},
  keywords     = {COLORECTAL-CANCER,DECISION-ANALYSIS,RESECTION,SURGERY,OXALIPLATIN,MULTICENTER,bowel-first approach,decision analysis,liver-first approach,reversed,approach,synchronous liver metastases},
  language     = {eng},
  number       = {3},
  pages        = {415--422},
  title        = {Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases},
  url          = {http://dx.doi.org/10.1002/jso.25516},
  volume       = {120},
  year         = {2019},
}

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