Intestinal complications after palliative treatment for asymptomatic patients with unresectable stage IV colorectal cancer

Seo, Guh Jung; Park, Ji Won; Yoo, Sang Bum; Kim, Sun Young; Choi, Hyo Seong; Chang, Hee Jin; Shin, Aesun; Jeong, Seung‐Yong; Kim, Dae Yong; Oh, Jae Hwan

doi:10.1002/jso.21577

Cited by 67 publications

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“…Thirty-seven potentially eligible articles underwent full-text assessment to determine their eligibility for inclusion in the final analysis. Fifteen studies (reported in fourteen articles) were identified as meeting the eligibility criteria [6][7][8][9][10][11][12][21][22][23][24][25][26] . Kappa agreement scores between the two abstractors with respect to "screening for the citations" and "full-text screening" were 0.68 and 0.86 respectively, suggesting substantial-to-excellent agreement.…”

Section: Analysis and Synthesis Of Resultsmentioning

confidence: 99%

“…d Six studies provided information about extent of liver involvement 6,11,12,21,25,26 . e Five studies provided information about peritoneal disease 8,10,21,25,26 .…”

Section: Discussionmentioning

confidence: 99%

“…f Five studies provided data about palliative radiation 10,13,23,24,26 . g One study did not provide information about chemotherapy 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Notably, the test for heterogeneity was no longer significant after exclusion from the pool of three studies that had either larger 6,9,12,13,21,23,24 . d Six studies provided information about extent of liver involvement 6,11,12,21,25,26 . e Five studies provided information about peritoneal disease 8,10,21,25,26 .…”

mentioning

confidence: 99%

“…d Six studies provided information about extent of liver involvement 6,11,12,21,25,26 . e Five studies provided information about peritoneal disease 8,10,21,25,26 .f Five studies provided data about palliative radiation 10,13,23,24,26 . g One study did not provide information about chemotherapy 9 .…”

mentioning

confidence: 99%

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

et al. 2013

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rate was 29.7% (95% ci: 18.5% to 41.0%), and the non-resection surgical procedures rate in the nonresection group was 27.6% (95 ci: 15.4% to 39.9%). No study provided qol data. ConclusionsAlthough this review supports primary tumour resection in advanced crc, the results have significant biases. Randomized trials are warranted to confirm the findings. KEY WORDSPrimary tumour resection, stage iv colorectal cancer, palliative surgery, survival INTRODUCTIONColorectal cancer (crc) is one of the leading causes of cancer death in North America 1 . The median overall survival of patients with stage iv crc managed with best supportive care alone is about 5-6 months 2 . Systemic therapy provides meaningful improvements in median survival and progression-free survival. Overall, with the judicious use of novel cytotoxic and biologic agents, the median overall survival of patients with stage iv crc has been extended to approximately 2 years [3][4][5] .The optimal surgical management of stage iv crc that is not amenable to curative resection is unknown. Although administration of systemic therapy in patients with stage iv crc may convert unresectable into resectable disease, the principal goal of treatment in most patients is to prolong survival, and only about 10%-15% patients are alive at 5 years. Consequently, in patients with stage iv crc, the potential morbidity of treatment and the treatment's impact on quality of life (qol) for the patient must be considered.Resection of the primary tumour in patients with stage iv cancer is often performed to deal with presenting primary tumour symptoms and ABSTRACT PurposeSurgical resection of the primary tumour in patients with advanced colorectal cancer (crc) remains controversial. This review compares survival in patients with advanced crc who underwent surgical resection of the primary tumour with that in patients not undergoing resection, and determines rates of postoperative mortality and nonfatal complications, the primary tumour complication rate, the non-resection surgical procedures rate, and quality of life (qol). MethodsReports in the central, medline, and embase databases were searched for relevant studies, which were selected using pre-specified eligibility criteria. The search was also restricted to publication dates from 1980 onward, the English language, and studies involving human subjects. Screening, evaluation of relevant articles, and data abstraction were performed in duplicate, and agreement between the abstractors was assessed. Articles that met the inclusion criteria were assessed for quality using the Newcastle-Ottawa Scale. Data were collected and synthesized per protocol. ResultsFrom among the 3379 reports located, fifteen retrospective observational studies were selected. Of the 12,416 patients in the selected studies, 8620 (69%) underwent surgery. Median survival was 15.2 months (range: 10-30.7 months) in the resection group and 11.4 months (range: 3-22 months) in the nonresection group. Hazard ratio for survival was 0.69 [95% confidence interval (ci): ...

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Section: Analysis and Synthesis Of Resultsmentioning

confidence: 99%

“…d Six studies provided information about extent of liver involvement 6,11,12,21,25,26 . e Five studies provided information about peritoneal disease 8,10,21,25,26 .…”

Section: Discussionmentioning

confidence: 99%

“…f Five studies provided data about palliative radiation 10,13,23,24,26 . g One study did not provide information about chemotherapy 9 .…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2013

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Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment

et al. 2021

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The role of primary tumor resection (PTR) in synchronous patients with metastatic colorectal cancer (mCRC) who had unresectable metastases and few or absent symptoms of their primary tumor is unclear. Studying subgroups with low postoperative mortality may identify patients who potentially benefit from PTR.OBJECTIVE To determine the difference in 60-day mortality between patients randomized to systemic treatment only vs PTR followed by systemic treatment, and to explore risk factors associated with 60-day mortality.DESIGN, SETTING, AND PARTICIPANTS CAIRO4 is a randomized phase 3 trial initiated in 2012 in which patients with mCRC were randomized to systemic treatment only or PTR followed by systemic treatment with palliative intent. This multicenter study was conducted by the Danish and Dutch Colorectal Cancer Group in general and academic hospitals in Denmark and the Netherlands. Patients included between August 2012 and December 2019 with histologically proven colorectal cancer, unresectable metastases, and a primary tumor with few or absent symptoms were eligible.INTERVENTIONS Systemic treatment, consisting of fluoropyrimidine-based chemotherapy with bevacizumab vs PTR followed by fluoropyrimidine-based chemotherapy with bevacizumab. MAIN OUTCOMES AND MEASURESThe aim of the current analysis was to compare 60-day mortality rates in both treatment arms. A secondary aim was the identification of risk factors for 60-day mortality in the treatment arms. These aims were not predefined in the study protocol.RESULTS A total of 196 patients were included in the intention-to-treat analysis (112 [57%] men; median [IQR] age, 65 [59-70] years). Sixty-day mortality was 3% (95% CI, 1%-9%) in the systemic treatment arm and 11% (95% CI, 6%-19%) in the PTR arm (P = .03). In a per-protocol analysis, 60-day mortality was 2% (95% CI, 1%-7%) vs 10% (95% CI, 5%-18%; P = .048). Patients with elevated serum levels of lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, and/or neutrophils who were randomized to PTR had a significantly higher 60-day mortality than patients without these characteristics.CONCLUSIONS AND RELEVANCE Patients with mCRC who were randomized to PTR followed by systemic treatment had a higher 60-day mortality than patients randomized to systemic treatment. Especially patients randomized to the PTR arm with elevated serum levels of lactate dehydrogenase, neutrophils, aspartate aminotransferase, and/or alanine aminotransferase were at high risk of postoperative mortality. Final study results on overall survival have to be awaited.

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Non-resection versus resection for an asymptomatic primary tumor in patients with unresectable Stage IV colorectal cancer.

Gullà

Cirocchi

Boselli

et al. 2011

Cochrane Database of Systematic Reviews

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Intestinal complications after palliative treatment for asymptomatic patients with unresectable stage IV colorectal cancer

Abstract: In asymptomatic patients with unresectable stage IV CRC, first-line chemotherapy may be considered safe, with no increased risk of major intestinal complications compared with primary tumor resection plus chemotherapy.

Cited by 67 publications

References 30 publications

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

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

Sixty-Day Mortality of Patients With Metastatic Colorectal Cancer Randomized to Systemic Treatment vs Primary Tumor Resection Followed by Systemic Treatment

Non-resection versus resection for an asymptomatic primary tumor in patients with unresectable Stage IV colorectal cancer.

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