Factors affecting survival after palliative resection of colorectal carcinoma

Abstract

OBJECTIVE: To determine the factors affecting survival following palliative large bowel resection for colorectal adenocarcinoma. PATIENTS AND METHOD: From the Colorectal Cancer Database of a single institution patients who had a palliative resection of a colorectal cancer from 1980 to 1993 inclusive were identified. Survival curves were constructed using the Kaplan-Meier method. Criteria studied were sex, age at operation, site of tumour, T, N and M status, tumour differentiation, involvement of tumour margins, tumour fixity and the presence or absence of peritoneal, liver or distant metastases. Multivariate analysis of factors was conducted using Cox proportional hazards analysis. RESULTS: Three hundred and seventy-seven patients (232 men, 145 women, median age 64 years) fitted the above criteria. Operative mortality was 5.6%. Crude 6 month survival rate was 71.1% and median survival 10.5 months. Significant factors affecting survival on univariate analysis were - Age (<75 vs. >75 years) (P=0.019); T status (T1/T2 vs. T3/T4) (P=0.039); nodal status (N0 vs. N1/N2) (P=0.0059); distant metastases (P=0.039) or liver metastases (P=0.0058); tumour differentiation (poor vs. moderate/well differentiated) (P < 0.001); involved tumour margins (P < 0.001). Multivariate analysis found the following factors significant: age (P=0.02), liver metastases (P=0.05), distant metastases (P=0.044), T status (P=0.042), nodal status (P=0.0063), tumour differentiation (P < 0.001) and involvement of tumour margins (P < 0.001). CONCLUSIONS: The data suggest that palliative resection of advanced colorectal carcinoma should be considered carefully in patients with advanced age, where distant metastases are present and in cases when primary tumours can not be completely resected. For the remaining patients, palliative resection may be accomplished with acceptable operative mortality and postoperative survival.

Elective palliative resection of incurable stage IV colorectal cancer: Who really benefits from it?

“…The 15 tested variables include the majority of parameters proposed in the literature to be associated with prognosis, 4,8,11,[13][14][15][16][17][18][19][20][21][22][23][24][25] with the exception of serum carcinoembryonic antigen 34 and C-reactive protein 35 (these parameters were not routinely tested before surgery in incurable CRC patients in this environment, thus they were available in less than half of the patients, and excluded from the analysis). In consideration of several other treatments proposed to improve survival in association with surgery, 36-38 this study represents a rare opportunity to evaluate those prognostic factors in a homogeneous class of patients undergoing a palliative resection alone, because it is not feasible, nor indeed ethically correct, to refuse any complementary treatment to such a large cohort of patients nowadays.…”

“…4,[8][9][10][13][14][15]17,22 Among the few papers considering nonemergency patients, Joffe and Gordon 15 report 10% mortality and 50% morbidity rates, thus suggesting the exclusion from resection of patients older than 75 and/or with a previous history of cardiovascular disease. However, the fact that this series is from the early 1970s may possibly account for the high number of infectious complications (69.6% of total complications).…”

“…1). In accordance with the prognostic factors most often reported to be related to survival, 4,8,11,[13][14][15][16][17][18][19][20][21][22][23][24] 15 variables were compared with respect to the outcome, expressed as (1) perioperative mortality and (2) median survival (Table 1). According to a parameter we recently found 25 to be related to prognosis of patients presenting incurable CRC at surgical exploration, the "metastatization pattern," patients were divided into as having a "local" (locally advanced) or a "systemic" (carcinosis/distant metastasis, regardless of local extension) disease.…”

“…Since patients with incurable CRC have a limited life expectancy and surgery is reported to have relevant perioperative morbidity and mortality, 9,[12][13][14] the identifi cation of prognostic factors relating to outcome may allow to select surgery for only those who may benefi t from it. A retrospective analysis was conducted of 15 prognostic factors in 71 "non-emergency" patients affected by fi rstonset, incurable CRC not undergoing any therapy other than resection of the primary tumor, in order to defi ne a class of patients affected by incurable CRC where a palliative surgical resection of the primitive tumor may be justifi ed by an adequate postoperative life expectancy.…”

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

“…Of twenty-three full-text articles that were excluded, twelve had no comparator nonsurgical group [27][28][29][30][31][32][33][34][35][36][37][38] ; four used a non-resection group (that is, ostomy procedures) as comparators [39][40][41][42] ; and another four used patients who underwent curative surgery as the comparator group [43][44][45][46] . Two studies, each with four comparator groups, provided minimal information about those groups, and one had a patient population that overlapped with the population of another study included in the present review 14,47 .…”