Impact of metastases on survival 77 CHAPTER 5 Results Patients Of the 349 patients who met the selection criteria, 261 (75 percent) never had distant metastases, 42 (12 percent) had a history of metastases and 46 (13 percent) had synchronous metastases; 14/46 patients also had a history of metastases. All included patients underwent pelvic surgery as well as treatment for their metastatic disease. Patient characteristics and details of the primary and recurrent tumour are shown in Tables 1 and 2, respectively. Patients with synchronous metastases had a shorter interval between resection of the primary tumour and the LRRC (26 months) than patientswithoutmetastases and patientswith a history ofmetastases (31 and 42months respectively, P = 0.014). Patients with synchronous metastases more often received induction chemotherapy for their LRRC than patients without or those with a history of metastases (P = 0.033), and the latter more often underwent (chemo)reirradiation for the LRRC than patients with synchronous metastases, who underwent full- course (chemo) radiotherapymore often (P =0.012). Intraoperative radiotherapywas delivered in 82.8 percent of the patients. Amultivisceral resectionwas performed in 238 patients; details about the organs resectedwith thismultivisceral resection are show in Table S1. Location and treatment of metastases Details about the types of metastases are shown in Table 3. Themajority of the patients with a history of metastases had liver metastases (n = 23, 54 percent), which were mainly treated with metastasectomy (n = 22). Thirteen patients had lung metastases (31 percent), mainly treated with metastasectomy (n = 11). Seven patients (17 percent) had peritoneal metastases that were treated with CRS ± HIPEC. Patients with synchronous metastases mostly presented with liver or peritoneal metastases (n = 15 and n = 18, 32 percent and 39 percent, respectively), which were mainly treatedwithmetastasectomy (n = 11) or CRS±HIPEC, respectively. Lymph node metastases (n = 6, 13 percent) either disappeared after neoadjuvant treatment (n = 3) or required additional lymphadenectomy (n = 3).
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