Shingo Ito1,2*, Kazuhiro Sakamoto1, Kiichi Sugimoto1, Makoto Takahashi1, Yukata Kojima1 and Yuichi Tomiki1
1Department of Coloproctological Surgery, Juntendo University, Japan
2Department of Gastroenterological Surgery, Kawasaki Saiwai Hospital, Japan
Background: The benefits of primary tumor resection without metastasectomy in patients with stage IV noncurative colorectal cancer remain controversial. In our hospital, we perform primary tumor resections to avoid complications related to the tumor, regardless of whether the patients are symptomatic. This study aimed to evaluate the prognostic factors and long-term outcomes after primary tumor resection with or without metastasectomy in patients with stage IV colorectal cancer. Methods: We retrospectively reviewed 130 consecutive patients with stage IV colorectal cancer who underwent primary tumor resection without metastasectomy (primary resection) or primary tumor resection with metastasectomy (R0 resection) at Juntendo University Hospital between January 2007 and December 2013. Results: The median duration of observation was 22.5 months (range 30 to 50). The 5-year overall survival rate for all the patients was 13.8%, with a median survival time of 26 months. Of the 130 patients, 59 (45.4%) underwent primary resections, and 71 (54.6%) underwent R0 resections. In univariate analysis, significantly shorter overall survival was associated with age >60 years, peritoneal metastases, palliative resection, poorly differentiated adenocarcinoma, mucinous adenocarcinoma, or signet-ring cell carcinoma (Por/Muc/Sig) histological types, lymphatic invasion, and ≥ 2 metastatic sites. Multivariate analysis suggested that Por/Muc/Sig histological types, lymphatic invasion, and palliative resection were independent prognostic factors for poor survival. Conclusion: The patients with Por/Muc/Sig histological types or lymphatic invasion, or who underwent palliative resection, showed significantly lower survival rates than other patients with stage IV colorectal cancer. It is possible that preoperative chemotherapy or chemoradiation therapy might contribute to improve their prognosis.
Ito S, Sakamoto K, Sugimoto K, Takahashi M, Kojima Y, Tomiki Y. Prognostic Factors for Stage IV Colorectal Cancer after Primary Tumor Resection: A Single-Institutional Retrospective Analysis. Clin Surg. 2020; 5: 2904..