Elective colon resection without curative intent in stage IV colon cancer

• Published in: Surgical oncology Vol. 28; pp. 110 - 115
• Main Authors: Birkett, Richard T., O'Donnell, MAJ.Mary T., Epstein, Andrew J., Saur, Nicole M., Bleier, Joshua I.S., Paulson, Emily Carter
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2019; Elsevier Limited
• Subjects: African Americans; Age; Cancer; Cancer therapies; Chemotherapy; Colon; Colon cancer; Colorectal cancer; Comorbidity; Disease; Gender; Government programs; Health risks; Laparoscopy; Liver; Liver cancer; Metastases; Metastasis; Metastatic; Multivariate analysis; Patients; Poverty; Regression analysis; Resection; Rural areas; Socioeconomic factors; Survival; Survival analysis; Tumors; Unresectable; Variables; United States > US; Unresectable; Metastatic; Colon cancer; Resection
• ISSN: 0960-7404; 1879-3320
• DOI: 10.1016/j.suronc.2018.11.010

Evidence suggests that elective primary colon resection (ePCR) in patients with asymptomatic colon tumors and unresectable metastases is not required and may expose patients to unnecessary operative risk. Stage IV colon cancer patients with liver metastases from 2000 to 2011 were identified with SEER-Medicare data. Liver-based therapy or urgent/emergent colectomies were excluded. Chemotherapy alone was compared to ePCR ± chemotherapy. Univariate and multivariate analyses were used to identify predictors of ePCR. Multivariate Cox regression compared survival. 5139 patients were identified. The ePCR rate decreased over time; 84% underwent ePCR in 2000, compared to 52% in 2011 (p < 0.001). In multivariate analysis, older patients were more likely to undergo ePCR, as were patients from rural areas (OR 1.65, p < 0.001). The odds of PCR in high poverty areas (>10%) were almost 25% higher than those in low poverty areas (OR 1.23, p = 0.03). African-Americana were less likely to undergo PCR than Caucasians (OR 0.76, p = 0.01). In multivariate survival analysis, PCR was associated with a significant survival benefit (HR 0.59, p < 0.001). Although ePCR is not recommended with unresectable metastases and the rate has decreased significantly, over 50% of patients with untreated hepatic metastases underwent ePCR in 2011. Disparities exist in use of ePCR that are likely multifactorial and deserve further study. •Rates of primary colon resection in stage IV colon cancer have decreased over time.•Disparities in use of colon resection exist for stage IV colon cancer patients.•Patients from rural or poor regions had higher rates of primary colon resection.•Older patients and more proximal tumors had higher rates of primary colon resection. SEER-Medicare database was used to identify disparities of primary tumor resection versus chemotherapy only in the setting of Stage IV liver disease. Higher rates of primary tumor resection were found in patients who are older, Caucasian from impoverished areas, and from non-metro areas while a small but significant survival benefit was demonstrated.