Management of Stage-IV Rectal Cancer with Liver Metastasis

A 65-year-old woman was diagnosed with rectal cancer with isolated liver metastasis (3 tumours, seg 1, 6 and 7) in February 2022 on evaluation for rectal bleeding. Follow-up PET-CT and MRI revealed significant responses in both rectal and liver lesions after initial chemotherapy. Subsequently, a Right Hepatectomy with partial caudate resection, incorporating all liver lesions, was done at Max Super Speciality Hospital, Patparganj, on 27th April 2022. After an uneventful recovery, she was discharged on 4th May 2022. The final biopsy was consistent with metastatic adenocarcinoma. She was then treated with short-course radiotherapy for treating the primary rectal cancer and then received chemotherapy, followed by primary rectal cancer on 24th August 2022. She subsequently completed chemotherapy and underwent ileostomy closure on 7th November 2022.

Stage-IV colorectal cancer with limited liver, lung, or peritoneal disease can still be cured with multidisciplinary management. Up to 40% of 5-year survivals are reported in patients with resectable liver metastases.

Optimum and timely planned combined use of chemotherapy, radiotherapy, interventional radiologic techniques and surgery for resection of metastatic lesions, either simultaneously with the primary tumour for minor liver resections or as staged surgery for major liver resection, as in this case, can help achieve good survival with minimal morbidity and mortality.