Simultaneous Resection Is Associated With Long‐Term Survival in Patients With High‐Risk Synchronous Rectal Cancer Liver Metastases

ABSTRACT Background and Objectives Simultaneous rectal and hepatic resection for metastatic rectal cancer is less commonly performed due to concerns about safety, and the oncological outcomes are less well described. The objective of this study is to examine peri‐operative and oncological outcomes for patients with rectal cancer liver metastases (RCLM) after simultaneous resection. Methods A single‐center, retrospective analysis of patients who underwent curative‐intent, simultaneous total mesorectal excision (TME) and hepatectomy for RCLM (January 2011 to May 2024). Post‐operative safety and oncological outcomes were examined. Results 92 patients were analyzed, with the majority having high burden of hepatic metastases. No deaths occurred. 14 patients (15%) had > Clavien‐Dindo Grade 3 complication, drainage of perihepatic fluid in eight patients (9%), and an anastomotic dehiscence in three patients (3%). Median follow up was 51 mo, and median OS was 70 mo, RFS was 10 mo, and H‐RFS was 17 mo. Positive hepatic margin was associated with decreased OS, while a high Clinical Risk Score, a high Tumor Burden Score, and > 6 cycles of neoadjuvant chemotherapy were associated with decreased RFS and H‐RFS. Conclusion Simultaneous resection of RCLM was associated with peri‐operative safety and long term survival in patients with high‐risk disease, and can be reasonably offered in appropriate setting.