Tetsuro Tominaga1,2, Takashi Nonaka3, Toshio Shiraisi4, Kiyoaki Hamada4, Keisuke Noda4, Hiroaki Takeshita5, Keizaburo Maruyama6, Hidetoshi Fukuoka6, Hideo Wada7, Shintaro Hashimoto8, Terumitsu Sawai3, Takeshi Nagayasu3. 1. Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. tetsuro.tominaga@nagasaki-u.ac.jp. 2. Department of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. tetsuro.tominaga@nagasaki-u.ac.jp. 3. Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. 4. Department of Surgery, Sasebo City General Hospital, Sasebo, Japan. 5. Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan. 6. Department of Surgery, Isahaya General Hospital, Isahaya, Japan. 7. Department of Surgery, Ureshino Medical Center, Saga, Japan. 8. Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan.
Abstract
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.
BACKGROUND: The effectiveness of primary tumor resection (PTR) for asymptomatic stage IV colorectal cancerpatients 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 cancerpatients 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.
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