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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-09

AUTHORS

Axel Kleespies, Kathrin E. Füessl, Hendrik Seeliger, Martin E. Eichhorn, Mario H. Müller, Markus Rentsch, Wolfgang E. Thasler, Martin K. Angele, Martin E. Kreis, Karl-Walter Jauch

ABSTRACT

PURPOSE: The benefit of elective primary tumor resection for non-curable stage IV colorectal cancer (CRC) remains largely undefined. We wanted to identify risk factors for postoperative complications and short survival. METHODS: Using a prospective database, we analyzed potential risk factors in 233 patients, who were electively operated for non-curable stage IV CRC between 1996 and 2002. Patients with recurrent tumors, resectable metastases, emergency operations, and non-resective surgery were excluded. Risk factors for increased postoperative morbidity and limited postoperative survival were identified by multivariate analyses. RESULTS: Patients with colon cancer (CC = 156) and rectal cancer (RC = 77) were comparable with regard to age, sex, comorbidity, American Society of Anesthesiologists score, carcinoembryonic antigen levels, hepatic spread, tumor grade, resection margins, 30-day mortality (CC 5.1%, RC 3.9%) and postoperative chemotherapy. pT4 tumors, carcinomatosis, and non-anatomical resections were more common in colon cancer patients, whereas enterostomies (CC 1.3%, RC 67.5%, p < 0.0001), anastomotic leaks (CC 7.7%, RC 24.2%, p = 0.002), and total surgical complications (CC 19.9%, RC 40.3%, p = 0.001) were more frequent after rectal surgery. Independent determinants of an increased postoperative morbidity were primary rectal cancer, hepatic tumor load >50%, and comorbidity >1 organ. Prognostic factors for limited postoperative survival were hepatic tumor load >50%, pT4 tumors, lymphatic spread, R1-2 resection, and lack of chemotherapy. CONCLUSIONS: Palliative resection is associated with a particularly unfavorable outcome in rectal cancer patients presenting with a locally advanced tumor (pT4, expected R2 resection) or an extensive comorbidity, and in all CRC patients who show a hepatic tumor load >50%. For such patients, surgery might be contraindicated unless the tumor is immediately life-threatening. More... »

PAGES

1097

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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00384-009-0734-y

    DOI

    http://dx.doi.org/10.1007/s00384-009-0734-y

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1034386491

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/19495779


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