An international expert collaborative has issued consensus recommendations on the management of advanced rectal cancer with synchronous liver metastases.
The PelvEx collaborative used a modified Delphi consensus methodology to develop clinical guidance based on best management practice.
The consensus was that MRI of the liver should be reserved for patients with suspicious abnormalities on CT of the thorax, abdomen and pelvis.
There was no consensus that PET-CT should be performed prior to considering pelvic exenteration. There was consensus that induction chemotherapy should be offered.
In the setting of symptomatic disease such as obstruction or fistulation due to local invasion, the majority recommended a diverting stoma before commencing chemotherapy on the basis that this might downstage non-resectable or borderline resectable tumours and increase R0 resection margin rates.
Only 25 per cent of participants would routinely consider simultaneous pelvic exenteration and liver resection: 10 per cent would never consider this option and the remainder considered synchronous resection only suitable if a limited liver resection with favourable localisation was evident.
As expected, the majority of participants would recommend adjuvant therapy, even following R0 resection. There was no consensus on length of treatment or type of adjuvant therapy.
The recommendations are published in the journal Colorectal Disease.