IMPACT OF PRIMARY TUMOR RESECTION ON SURVIVAL FOR INCURABLE AND ASYMPTOMATIC STAGE IV COLORECTAL CANCER AND INCIDENCE OF PRIMARY TUMOR RELATED COMPLICATIONS IN UNRESECTED PATIENTS: RESULTS OF A SINGLE-INSTITUTION RETROSPECTIVE STUDY

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Abstract

Background

Primary tumor resection is recommended to manage symptoms such as perforation, obstruction, and bleeding in patients with incurable stage IV colorectal cancer. However, management of asymptomatic patients has not been established.

Methods

We carried out a retrospective analysis in seventy-seven asymptomatic patients who started chemotherapy with the diagnosis of incurable stage IV colorectal cancer at our institution between March of 2006 and August of 2011. As for impact of primary tumor resection on survival, we compared overall survival between resected and unresected patients and evaluated some predictive factors in association with survival. In unresected patients, we evaluated incidence of primary tumor related complications and some predictive factors associated with the incidence of complications.

Results

Median follow-up period was 14.0 months. A total of 37 patients underwent resection of the primary tumor, whereas 40 patients were managed without resection. Patient characteristics were well-balanced between the two groups. Resected patients had significantly better median survival time compared with unresected patients (24.3 versus 14.0 months). Perioperative complications in resected patients were low in both frequency and severity, and the period from resection to either discharge or start of chemotherapy was not significantly extended. Univariable analysis identified three significant predictive factors of survival: location of primary tumor, number of distant metastasis, and ALP, and ALP was also a significant predictor of survival in multivariable analysis. Incidence of primary tumor related complications was 25%, and univariable analysis identified no predictive factors.

Conclusions

Primary tumor resection in patients with incurable and asymptomatic stage IV colorectal cancer may be associated with better overall survival, and primary tumor related complications may be unavoidable to some extent in unresected patients. We plan to present the updated results with extended follow-up period at the presentation.

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