Hépato-Gastro & Oncologie Digestive
MENUPrise en charge des adénocarcinomes du rectum avec métastases hépatiques synchrones Volume 18, issue 2, Mars-Avril 2011
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- Key words: rectal cancer, synchronous hepatic metastases, therapeutic strategy
- DOI : 10.1684/hpg.2011.0556
- Page(s) : 146-54
- Published in: 2011
At diagnosis of rectal adenocarcinoma, about 20% of patients present with synchronous metastases. Therapeutic management is controversial and depends mainly on the resectability of metastases, presence of pelvic symptoms, patient co-morbidities and overall prognosis. The aims of treatment are both to prolong survival and to ensure good quality of life. For locally advanced tumors with resectable synchronous liver metastases, preoperative chemoradiation 5FU plus oxaliplatin is the treatment of choice. Resection is possible in one-step surgery in the absence of complex hepatectomy. Adjuvant chemotherapy with 5FU plus oxaliplatin may be carried out. No prospective randomized study effectively helps to determine therapeutic choice in the event of unresectable synchronous liver metastases. For patients with a good prognosis, we should always consider rectal resection as a means of preventing debilitating pelvic symptoms. In patients who are asymptomatic with regard to rectal tumor, chemotherapy allows first for a quick evaluation of chemosensitivity, and then a prognosis. In symptomatic patients, radiochemotherapy facilitates initial treatment of local and metastatic disease. Prospective strategy studies are needed to clarify the modalities of therapeutic management for patients with metastatic rectal cancer.