Outcomes in the management of obstructive unresectable stage IV colorectal cancer

Frago, Ricardo; Kreisler, Esther; Biondo, Sebastiano; Salazar, Ramón; Domínguez, Juan M.; Escalante, E.

doi:10.1016/j.ejso.2010.09.005

Cited by 28 publications

(11 citation statements)

References 25 publications

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“…In distal obstruction, we consider self‐expanding metallic stents as a bridge to surgery after resuscitation. The mortality rate in our institution after stenting is 6.1%, as described in a recent study [24].…”

Section: Discussionmentioning

confidence: 83%

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Differences between proximal and distal obstructing colonic cancer after curative surgery

et al. 2011

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Section: Discussionmentioning

confidence: 83%

“…Intestinal continuity was preserved in 98.8% of proximal obstructions and in 82.8% of distal obstructions ( P < 0.001). Colonic stents were reserved for some ASA IV patients and unresectable stage IV colorectal cancer [24].…”

Section: Discussionmentioning

confidence: 99%

Differences between proximal and distal obstructing colonic cancer after curative surgery

et al. 2011

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“…In group 1, the median OS was statistically significantly better in resected versus nonresected patients in 8 of 12 studies 13 , 19 , 21 , 27 , 28 , 35 , 37 , 38. The conclusion of most of these studies was that resection should be performed if feasible, in particular in symptomatic patients (Table 3).…”

Section: Resultsmentioning

confidence: 99%

Prognostic Value of Resection of Primary Tumor in Patients with Stage IV Colorectal Cancer: Retrospective Analysis of Two Randomized Studies and a Review of the Literature

et al. 2011

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BackgroundIn patients with metastatic colorectal cancer (mCRC) with an asymptomatic primary tumor, there is no consensus on the indication for resection of the primary tumor.MethodsA retrospective analysis was performed on the outcome of stage IV colorectal cancer (CRC) patients with or without resection of the primary tumor treated in the phase III CAIRO and CAIRO2 studies. A review of the literature was performed.ResultsIn the CAIRO and CAIRO2 studies, 258 and 289 patients had undergone a primary tumor resection and 141 and 159 patients had not, respectively. In the CAIRO study, a significantly better median overall survival and progression-free survival was observed for the resection compared to the nonresection group, with 16.7 vs. 11.4 months [P < 0.0001, hazard ratio (HR) 0.61], and 6.7 vs. 5.9 months (P = 0.004; HR 0.74), respectively. In the CAIRO2 study, median overall survival and progression-free survival were also significantly better for the resection compared to the nonresection group, with 20.7 vs. 13.4 months (P < 0.0001; HR 0.65) and 10.5 vs. 7.8 months (P = 0.014; HR 0.78), respectively. These differences remained significant in multivariate analyses. Our review identified 22 nonrandomized studies, most of which showed improved survival for mCRC patients who underwent resection of the primary tumor.ConclusionsOur results as well as data from literature indicate that resection of the primary tumor is a prognostic factor for survival in stage IV CRC patients. The potential bias of these results warrants prospective studies on the value of resection of primary tumor in this setting; such studies are currently being planned.

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“…Of twenty-three full-text articles that were excluded, twelve had no comparator nonsurgical group [27][28][29][30][31][32][33][34][35][36][37][38] ; four used a non-resection group (that is, ostomy procedures) as comparators [39][40][41][42] ; and another four used patients who underwent curative surgery as the comparator group [43][44][45][46] . Two studies, each with four comparator groups, provided minimal information about those groups, and one had a patient population that overlapped with the population of another study included in the present review 14,47 .…”

Section: Study Selectionmentioning

confidence: 99%

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

et al. 2013

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rate was 29.7% (95% ci: 18.5% to 41.0%), and the non-resection surgical procedures rate in the nonresection group was 27.6% (95 ci: 15.4% to 39.9%). No study provided qol data. ConclusionsAlthough this review supports primary tumour resection in advanced crc, the results have significant biases. Randomized trials are warranted to confirm the findings. KEY WORDSPrimary tumour resection, stage iv colorectal cancer, palliative surgery, survival INTRODUCTIONColorectal cancer (crc) is one of the leading causes of cancer death in North America 1 . The median overall survival of patients with stage iv crc managed with best supportive care alone is about 5-6 months 2 . Systemic therapy provides meaningful improvements in median survival and progression-free survival. Overall, with the judicious use of novel cytotoxic and biologic agents, the median overall survival of patients with stage iv crc has been extended to approximately 2 years [3][4][5] .The optimal surgical management of stage iv crc that is not amenable to curative resection is unknown. Although administration of systemic therapy in patients with stage iv crc may convert unresectable into resectable disease, the principal goal of treatment in most patients is to prolong survival, and only about 10%-15% patients are alive at 5 years. Consequently, in patients with stage iv crc, the potential morbidity of treatment and the treatment's impact on quality of life (qol) for the patient must be considered.Resection of the primary tumour in patients with stage iv cancer is often performed to deal with presenting primary tumour symptoms and ABSTRACT PurposeSurgical resection of the primary tumour in patients with advanced colorectal cancer (crc) remains controversial. This review compares survival in patients with advanced crc who underwent surgical resection of the primary tumour with that in patients not undergoing resection, and determines rates of postoperative mortality and nonfatal complications, the primary tumour complication rate, the non-resection surgical procedures rate, and quality of life (qol). MethodsReports in the central, medline, and embase databases were searched for relevant studies, which were selected using pre-specified eligibility criteria. The search was also restricted to publication dates from 1980 onward, the English language, and studies involving human subjects. Screening, evaluation of relevant articles, and data abstraction were performed in duplicate, and agreement between the abstractors was assessed. Articles that met the inclusion criteria were assessed for quality using the Newcastle-Ottawa Scale. Data were collected and synthesized per protocol. ResultsFrom among the 3379 reports located, fifteen retrospective observational studies were selected. Of the 12,416 patients in the selected studies, 8620 (69%) underwent surgery. Median survival was 15.2 months (range: 10-30.7 months) in the resection group and 11.4 months (range: 3-22 months) in the nonresection group. Hazard ratio for survival was 0.69 [95% confidence interval (ci): ...

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Outcomes in the management of obstructive unresectable stage IV colorectal cancer

Cited by 28 publications

References 25 publications

Differences between proximal and distal obstructing colonic cancer after curative surgery

Differences between proximal and distal obstructing colonic cancer after curative surgery

Prognostic Value of Resection of Primary Tumor in Patients with Stage IV Colorectal Cancer: Retrospective Analysis of Two Randomized Studies and a Review of the Literature

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

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