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P72. Rectum preservation in patients with synchronous metastasis of rectal cancer to the liver

Thursday, March 5, 2026
3:14 PM - 3:21 PM MST
Location: 101A-C
Introduction:

Treatment of rectal cancer with synchronous metastasis to the liver (RCL) has evolved with adoption of total neoadjuvant therapy (TNT) and watch-and-wait (WW).


Methods:

An institutional database was searched for RCL diagnosed between 2011 and 2021. Overall survival (OS) and disease-free survival (DFS) with a preserved rectum were compared between patients diagnosed in 2011–2017 (early cohort) and patients diagnosed in 2018–2021, after institutional adoption of TNT and WW (late cohort).


Results:

Of 232 patients identified (median age 50 years, 151 [65%] male), 135 and 97 were in the early and late cohorts, respectively. Primary tumor location (distance from the anal verge) was as follows: low (0–5 cm), 62 patients (27%); mid (6–10 cm), 116 patients (50%); high (11–15 cm), 50 patients (22%); unknown, 4 patients (1.7%). Initial treatment was chemotherapy (CT) in 216 patients (93%). Secondary treatment was radiotherapy (RT) (66; 31%), combined liver and rectal resection with or without hepatic artery infusion pump (HAIP) (62 patients; 29%), liver resection with or without HAIP (37; 17%), rectal resection with or without HAIP (32; 15%), or HAIP only (19; 8.8%). Compared to patients with high tumors, patients with mid- or low-rectum tumors more commonly received pelvic RT immediately following initial CT (63 [38%] vs. 2 [4.4%] patients; p < 0.001) and were less likely to undergo combined liver and rectal resection (38 [23%] vs. 23 [51%] patients; p < 0.001) or any rectal resection (55 [33%] vs. 38 [84%] patients; p < 0.001). Compared to patients in the early cohort, patients with mid- or low-rectum tumors in the late cohort were more likely to receive RT (57 [77%] vs. 45 [43%] patients; p < 0.001) and to undergo a liver-first approach with observational management of the rectum (37 [50%] vs. 25 [24%] patients; p < 0.001). After a clinical complete response, the 2-year rate of regrowth was 44%, with a 21% competing risk of death. Two-year rates of DFS with a preserved rectum were 20% and 25% in the early and late cohorts, respectively; for patients with low- or mid-rectum tumors, the rates were 24% and 27% in the early and late cohorts, respectively. Median OS was 52 and 55 months in the early and late cohorts, respectively. At last follow-up, 37% of the patients were alive, with median follow-up of 70 months.


Conclusions:

Treatment of RCL (particularly for mid- and low-rectum tumors) has shifted toward rectum preservation (including a liver-first approach), without an adverse impact on OS. The concomitant increase in DFS with a preserved rectum is particularly important, considering the sustained high risk of competing events.

Learning Objectives:

  • Define how the treatment of rectal cancer with synchronous metastases to the liver has evolved over time.
  • Quantify the impact of these treatment changes on rectal preservation and overall survival.