Whilst I’m not a doctor/surgeon and haven’t seen his scans, depending on the locations those two liver lesions do sound potentially within the realm of resectable or ablatable (presuming those measurements are centimetres). The question is whether surgery would confer a material survival benefit in the presence of extrahepatic disease, and whether the potential risks and negative impacts of surgery warrant this.
Many surgeons are reluctant to operate if there will still be macroscopic disease left. The argument here is that if complete removal can’t be obtained, then the benefits do not justify the negative effects of surgery - in particular a couple of months off chemo, the diminished quality of life and risk of complications, plus the risks of creating a pro-metastatic environment for remaining tumours.
That said, isolated lung disease does sometimes appear to be an exception. Lung mets sometimes can grow very slowly, and may be treatable in future through things like ablation or radiation (SABR). Have they said why the lung mets are not considered operable, or considered any alternative treatments?
Since it was identified last year - have they proposed any intervention for the local recurrence? Whilst I would definitely still be getting the opinions of high-volume hepatobiliary and thoracic surgeons, rectal surgery may end up being the more complex consideration here - and perhaps a liver procedure (if appropriate) could be combined with that.
Best of luck,
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm high
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2, May-20=1.9, Jun-20=2.1
11/18 FOLFOX x6
3/19 Liver resect
5/19 25x pelvic VMAT radiation; complete met. response
07/19 Robot ULAR w ileo, 1/27 LN+
08/19 Found liver spot
08/19 FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19 Liver resect #2
02/20 Ileo reversed
03/20 NED (PET+MRI)
06/20 NED (CT+MRI)
07/20 Clear scope