Background: Hepatectomy in simultaneous operation with rectal cancer is technically challenging. It is feasible and safe in selected patients when the operations are performed in experienced centers. However, oncological outcomes of this operation have been inconclusive, especially in the type of hepatectomy that is combined with rectal cancer surgery.

Objective: To evaluate the perioperative and oncological outcomes of minor and major hepatectomy in simultaneous operation with rectal cancer.

Materials and Methods: Patients with synchronous rectal cancer with liver metastasis that underwent simultaneous resection between October 2005 and October 2019 were enrolled into the present study. The patients were divided into two groups, major and minor hepatectomy. Clinicopathological characteristics and surgical outcomes including complications, overall survival (OS) and progression-free survival (PFS) between the two groups were analyzed.

Results: Seventy-two patients, which included 54 patients in the minor hepatectomy group and 18 patients in the major hepatectomy group, were included in the present study. A comparative analysis of patient and tumor characteristics between the two groups found that the CEA level (p=0.023), the number (p=0.010), and size of liver metastasis (p=0.006) were higher in the major hepatectomy group. There was no difference in both minor and major complication rates between the two groups. The OS and PFS rates were significantly better in the minor hepatectomy group compared to the major hepatectomy group at 50.23 versus 24.03 months (p<0.001 and 21.60 versus 15.73 months (p=0.015), respectively. Multivariate analysis showed that primary tumor staging, diabetes, and major hepatectomy impacted both OS and PFS.

Conclusion: Minor hepatectomy in simultaneous operation with rectal cancer provides more favorable oncological outcomes. In case of rectal cancer associated with high tumor burden of liver metastasis, which required major hepatectomy, stage operation with either rectal-first or liver-first approach is more appropriate.

Keywords: Rectal cancer; Synchronous liver metastasis; Simultaneous operation

DOI: 10.35755/jmedassocthai.2022.06.13316

Received 11 April 2022 | Revised 21 April 2022 | Accepted 29 April 2022