Abstract
Advancement in systemic and regional radiation therapy, surgical technique, and anesthesia
has provided a path for increased long-term survival and potential cure for more patients
with stage IV rectal cancer in recent years. When patients have resectable disease,
the sequence for surgical resection is classified in three strategies: classic, simultaneous,
or combined, and reversed. The classic approach consists of rectal cancer resection
followed by metastatic disease at a subsequent operation. Simultaneous resection addresses
both rectal and metastatic disease in a single surgery. The reversed approach treats
metastatic disease first, followed by the primary tumor in several months. Simultaneous
resection is appropriate for selected patients to avoid delay of definitive surgery,
and reduce number of surgeries, hospital stay, and cost to the health care system.
It may also improve patients' psychological effect. Multidisciplinary discussions
including colorectal and liver surgeons to review patients' baseline medical conditions,
tumor biology and behavior, and disease burden and distribution is imperative to guide
proper patient selection for simultaneous resection and perioperative treatments.
Keywords
combined resection - simultaneous resection - synchronous liver metastasis
