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This article explores evolution of treatment options in colorectal cancer with synchronous metastatic disease, role of surgical approach on different stages of combined‑modality therapy, including “liver first” strategy. Prospects of perioperative and neoadjuvant polychemotherapy in patients with colorectal cancer with synchronous distant metastases to liver, data on possibility of using radiation therapy in treatment of primary tumor and liver metastases, as well as risks and benefits of this approach and available clinical research data are analyzed.

Objective: to evaluate feasibility and short-term results of the liver-first approach in our center.Materials and methods. Retrospective study of prospectively gathered group of patients who were treated in N. N. Blokhin National Medical Research Center of Oncology between 2017 and 2019. Patients with asymptomatic primary tumor located in rectum and rectosigmoid junction with synchronous resectable / borderline resectable metastasis in liver. 22 patients were planned to undergo the liver-first approach. Post-operative morbidity and mortality (Clavien–Dindo) as well as tumor regression grading (Dworak) were evaluated.Results. Of the 17 patients planned to undergo the liver-first strategy, the approach was completed in 15 (88,2 %) patients. The main reason for treatment failure was disease progression. Post-operative morbidity and mortality were 13,3 % and 0 %, respectively.Conclusions. Liver-first approach is justified in two cases: during waiting period after last day of chemoradiotherapy in patients with locally advanced (invasion depth T4a, positive circumferential resection margin, N+ status) mid-to-low rectal cancer and in patients with multiple borderline resectable bilobar liver damage.

This article presents the experience of surgical management of pancreatic and colon metastases from kidney cancer, detected 10 years after nephrectomy. Atypical resection of the pancreas combined with right-sided hemicolectomy was performed. The postoperative period turned out uneventful. Histological examination showed that lesions of pancreas and colon were metastases from a clear renal cell carcinoma. Disease progression was noted 2 years after surgery. The patient received appropriate treatment and was alive for 14 years after surgery.

Objective: to determine the efficacy of 2 oxaliplatin-based chemotherapy regimens (FOLFOX and XELOX) for metastatic colorectal cancer (CRC) depending on the KRAS mutation status and primary tumor location. Materials and methods. We performed retrospective analysis of the data on patients with metastatic CRC taken from a prospective database. We included patients with known KRAS mutation status that received either FOLFOX or XELOX without targeted drugs. Progression-free survival (PFS) was used as a main criterion in estimating treatment efficacy. Results. The inclusion criteria were met by 157 patients. The FOLFOX regimen was more effective in patients with wild-type KRAS CRC: median PFS was 10 months versus 8 months in the XELOX group (hazard ratio (HR) = 0.7; 95 % confidence interval (CI) 0.4–1.2; р = 0.1). However, we observed no significant differences in median life expectancy between these groups: it was 37 and 38 months respectively (HR = 1.1; 95 % CI 0.6–2.1; p = 0.6). Similar trends were observed in patients bearing KRAS mutations: median PFS in the FOLFOX group was 9 months vs 5 months in the XELOX group (HR = 0.6; 95 % CI 0.3–1.2; р = 0.1; p value by Breslow – Day test = 0.04). No differences in median life expectancy between these groups were observed: 33 and 23 months respectively (HR = 0.8; 95 % CI 0.4–1.6; p = 0.5). Conclusion. We failed to find an association between the KRAS mutation status and response to a particular chemotherapy regimen. We found that patients with metastatic CRC receiving the FOLFOX regimen were more likely to achieve objective responses and demonstrated higher median PFS than patients on the XELOX regimen.

A new approach to combined treatment of patients with colorectal cancer with synchronous distant liver metastases is discussed in the article. The approach is based on simultaneous surgical treatment of the colon using laparoscopic method and via open liver resection. This hybrid technology allows to reduce the frequency of postoperative complications, minimize the duration of in-patient care, therefore decreasing time until drugs administration as well as treatment costs, ensuring early start of combined treatment. The description of clinical observations demonstrated the benefits of this method implementation.