Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer

Kleespies, Axel; Füessl, Kathrin E.; Seeliger, Hendrik; Eichhorn, Martin; Müller, Mitho; Rentsch, Markus; Thasler, Wolfgang E.; Angele, Martin K.; Kreis, Martin E.; Jauch, Karl‐Walter

doi:10.1007/s00384-009-0734-y

Cited by 100 publications

(105 citation statements)

References 47 publications

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“…2,3 Of these obstructing cancers 75% are distal to the splenic flexure; the sigmoid colon being the most common location. 4 The traditional management of malignant colonic obstruction is surgical resection (with primary anastomosis or stoma formation) which has both high morbidity (40%-50%) and mortality (15%-20%). 5,6 In patients unfit for surgical resection, a defunctioning stoma only was typically performed.…”

Section: Introductionmentioning

confidence: 99%

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Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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Acute colonic obstruction secondary to left-colonic malignancy remains a common emergency condition. Traditional management is emergency surgery and has high morbidity and mortality. Self expandable metallic stents (SEMS) promised to improve morbidity and mortality, stoma rates and hospital stay. SEMS use in the potentially curative setting, as a bridge to surgery, is associated with an improved stoma rate and morbidity, but has no mortality benefit. There are concerns about oncological safety with higher local recurrence rates, thus SEMS is not recommended in this setting unless the patient has increased surgical risk and would benefit from a period of recovery prior to surgery. SEMS has a definite role in the palliative setting, for both patients with incurable disease or those with a high surgical risk. SEMS is associated with improved morbidity, mortality, and stoma rates. The technique for SEMS insertion is now well established but it is still unclear whether covered or uncovered stents are better.

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Section: Introductionmentioning

confidence: 99%

“…4,16 Although there are no RCTs to support this practice, surgery for right-sided colonic obstruction has lower morbidity and mortality than that for left sided obstruction, and SEMS placement is more challenging. 15 Rectal cancers have been excluded from all but one of the published RCTs on stenting.…”

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confidence: 99%

Colonic cancer: The current role of stent insertion

Newton

Hill

2017

Int J Gastrointest Interv

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“…1 Tumors distal to the splenic flexure represent 78% of all cases. 2 Up to 19% of patients will already have distant metastases at diagnosis, and two thirds of those will be considered unresectable. 2,3 Surgical resection of primary tumor and resectable metastasis combined with adjuvant or neoadjuvant therapy when indicated remains the potentially curative strategy for CRC.…”

Section: Introductionmentioning

confidence: 99%

“…2 Up to 19% of patients will already have distant metastases at diagnosis, and two thirds of those will be considered unresectable. 2,3 Surgical resection of primary tumor and resectable metastasis combined with adjuvant or neoadjuvant therapy when indicated remains the potentially curative strategy for CRC. 4 However, CRC with unresectable metastasis represents a heterogeneous group of patients ranging from isolated hepatic metastasis to diffuse intra and extra-abdominal metastatic disease whose treatment is based on chemotherapy and is prone to individualized management.…”

Section: Introductionmentioning

confidence: 99%

“…Both synchronic metastasis and bowel obstruction are considered poor prognosis factors as well as high preoperative levels of CA 19.9, histological grade, extension of liver metastasis or peritoneal metastases. 2,5,6 Resection of the primary tumour has been claimed to improve survival 7,8 but it has also been suggested that adding a surgical aggression to palliative patients with high volume disease may lead to high morbidity and mortality. The American Society of Clinical Oncology (ASCO) does not recommend resection of stage IV CRC in asymptomatic patients unless an intention to cure strategy is planned or when at risk of obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes in the management of obstructive unresectable stage IV colorectal cancer

Frago

Kreisler

Biondo

et al. 2010

European Journal of Surgical Oncology (EJSO)

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Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment

et al. 2021

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The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR.OBJECTIVE To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality.DESIGN, SETTING, AND PARTICIPANTS CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible.INTERVENTIONS Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab. MAIN OUTCOMES AND MEASURESThe aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol.RESULTS A total of 196 patients were included in the intention-to-treat analysis (112 [57%] men; median [IQR] age, 65 [59-70] years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics.CONCLUSIONS AND RELEVANCE Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited.

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Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer

Cited by 100 publications

References 47 publications

Colonic cancer: The current role of stent insertion

Colonic cancer: The current role of stent insertion

Outcomes in the management of obstructive unresectable stage IV colorectal cancer

Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment

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