{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:38:14Z","timestamp":1774352294213,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,8,2]],"date-time":"2017-08-02T00:00:00Z","timestamp":1501632000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003955","name":"Oslo University College","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003955","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>There is debate as to the correct treatment algorithm sequence for patients with locally advanced rectal cancer with liver metastases. The aim of the study was to assess safety, resectability and survival after a modified \u2018liver\u2010first\u2019 approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a retrospective study of patients undergoing preoperative radiotherapy for the primary rectal tumour, followed by liver resection and, finally, resection of the primary tumour. Short\u2010term surgical outcome, overall survival and recurrence\u2010free survival are reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2009 and 2013,\u00a045 patients underwent liver resection after preoperative radiotherapy. Thirty\u2010four patients (76%) received neoadjuvant chemotherapy, 24\u00a0(53%) concomitant chemotherapy during radiotherapy and 17 (43%) adjuvant chemotherapy. The median time interval from the last fraction of radiotherapy to liver resection and rectal surgery was 21 (range 7\u2013116) and 60 (range 31\u2013156)\u00a0days, respectively.\u00a0Rectal resection was performed in 42 patients but was not performed in one patient with complete response and two with progressive metastatic disease. After rectal surgery three patients did not proceed to a planned second stage liver (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>2) or lung (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>1) resection due to progressive disease. Clavien\u2013Dindo \u2265Grade <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> complications developed in 6.7% after liver resection and 19% after rectal resection. The median overall survival and recurrence\u2010free survival in the patients who completed the treatment sequence (<jats:italic>n\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>40) were 49.7 and 13.0\u00a0months, respectively. Twenty of the 30 patients who developed recurrence underwent further treatment with curative intent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The modified liver\u2010first approach is safe and efficient in patients with locally advanced rectal cancer and allows initial control of both the primary tumour and the liver metastases.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13622","type":"journal-article","created":{"date-parts":[[2017,2,9]],"date-time":"2017-02-09T06:42:39Z","timestamp":1486622559000},"page":"731-738","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short\u2010term surgical outcomes, overall survival and recurrence\u2010free survival"],"prefix":"10.1111","volume":"19","author":[{"given":"K. 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