Is abdominoperineal resection a good option for stage IV adenocarcinoma of the distal rectum?

Background and Objectives: The management of the primary lesion in patients with stage IV adenocarcinoma of the distal rectum is controversial. An abdominoperineal resection (APR) may be a good option. Methods: A retrospective analysis of the medical records of 21 patients with stage IV distal rectal adenocarcinoma treated with an APR between January 1991 to December 2000 was performed. Results: All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 and normal preoperative alkaline phosphatase and total bilirubin levels. Twelve patients (92%) with liver metastases had less than 25% of total liver volume involvement. Twenty patients (95%) had complete resolution of their symptoms related to the primary rectal cancer. The median follow-up was 19 months (range 3-92 months), with a median survival of 21.6 months and a 2-year overall survival of 34%. Conclusions: Patients with stage IV distal rectal adenocarcinoma who have a good performance status, normal preoperative liver function tests, and minimal metastatic disease to the liver can be offered resective surgery.