Factors related to short-term outcomes and delayed systemic treatment following primary tumor resection for asymptomatic stage IV colorectal cancer

• Published in: International journal of colorectal disease Vol. 35; no. 5; pp. 837 - 846
• Main Authors: Tominaga, Tetsuro, Nonaka, Takashi, Shiraisi, Toshio, Hamada, Kiyoaki, Noda, Keisuke, Takeshita, Hiroaki, Maruyama, Keizaburo, Fukuoka, Hidetoshi, Wada, Hideo, Hashimoto, Shintaro, Sawai, Terumitsu, Nagayasu, Takeshi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Chemotherapy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Female; Gastroenterology; Hepatology; Humans; Internal Medicine; Male; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Middle Aged; Morbidity; Neoplasm Metastasis; Neoplasm Staging; Original Article; Patients; Postoperative Complications - etiology; Proctology; Risk factors; Surgery; Survival; Time Factors; Treatment Outcome; Distant metastasis; Postoperative complication; Colorectal cancer; Primary tumor resection
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-020-03550-w

Background The effectiveness of primary tumor resection (PTR) for asymptomatic stage IV colorectal cancer patients to continue prolonged and safe systemic chemotherapy has recently been re-evaluated. However, postoperative complications lead to a prolonged hospital stay and delay systemic treatment, which could result in a poor oncologic outcome. The objective of this study was to identify the risk factors for morbidity and delay of systemic chemotherapy in such patients. Methods Between April 2016 and March 2018, 115 consecutive colorectal cancer patients with distant metastasis who had no clinical symptoms and underwent PTR in all participating hospitals were retrospectively reviewed. The patients were divided into two groups according to the presence (CD ≥ 2, n  = 23) or absence (CD < 2, n  = 92) of postoperative complications. Results The proportion of combined resection of adjacent organs was significantly higher in the postoperative complication group ( p  = 0.014). Complications were significantly correlated with longer hospital stay ( p  < 0.001) and delay of first postoperative treatment ( p  = 0.005). Univariate and multivariate analyses showed that combined resection (odds ratio 4.593, p  = 0.010) was the independent predictor for postoperative complications. Median survival time was 8.5 months. Postoperative complications were not associated with overall survival, but four patients (3.5%) could not receive systemic chemotherapy because of prolonged postoperative complications. Conclusions Although PTR for asymptomatic stage IV CRC patients showed an acceptable prognosis, appropriate patient selection is needed to obtain its true benefit.