Abstract
Background and aims
The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery.
Patients and methods
Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative resection was performed in 150 cases. Seventeen patients died in the postoperative period. Risk factors for postoperative mortality and poor survival were analysed with univariate and multivariate analysis.
Results
Multivariate analysis showed that operative mortality was significantly higher in patients with non-resection surgery and in those with ascites. Median survival of patients with resection was significantly longer than in those without resection (30 vs. 17 weeks). Other independent factors that were significantly associated poor survival were the presence of ascites, presence of bilobar liver metastasis and absence of chemotherapy and/or radiation therapy.
Conclusion
Non-curative surgery is associated with high mortality in patients without resection and in the presence of ascites. These two factors, together with the presence of bilobar liver metastasis and the absence of chemotherapy and/or radiation therapy, are associated with poor survival. In the presence of these factors the balance between the benefit and risk of surgery should be carefully considered before decision for operative treatment.
Similar content being viewed by others
References
Devesa JM, Morales V, Enriquez JM, Nuno J, Camunas J, Hemandez MJ et al (1988) Colorectal cancer. The bases for a comprehensive follow-up. Dis Colon Rectum 31:636–652
Liu SK, Church JM, Lavery 1C, Fazio VW (1997) Operation in patients with incurable colon cancer—is it worthwhile? Dis Colon Rectum 40:11–14
Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F et al (2000) Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg 135:530–534
Makela J, Haukipuro K, Laitinen S, Kairaluoma MI (1990) Palliative operations for colorectal cancer. Dis Colon Rectum 33:846–850
Joffe J, Gordon PH (1981) Palliative resection for colorectal carcinoma. Dis Colon Rectum 24:355–360
Law WL, Chu KW, Ho JW, Tung HM, Law SY, Chu KM (2000) Self-expanding metallic stent in the treatment of colonic obstruction caused by advanced malignancies. Dis Colon Rectum 43:1522–1527
Tejero E, Femandez-Lobato R, Mainar A, Montes C, Pinto I, Femandez L et al (1997) Initial results of a new procedure for treatment of malignant obstruction of the left colon. Dis Colon Rectum 40:432–436
Moran MR, Rothenberger DA, Lahr CJ, Buls JG, Goldberg SM (1987) Palliation for rectal cancer. Resection? Anastomosis? Arch Surg 122:640–643
Petrelli N, Herrera L, Rustum Y, Burke P, Creaven P, Stulc J et al (1987) A prospective randomized trial of 5-fluorouracil versus 5-fluorouracil and high-dose leucovorin versus 5-fluorouracil and methotrexate in previously untreated patients with advanced colorectal carcinoma. J Clin Oncol 5:1559–1565
Doroshow JH, MulthaufP, Leong L, Margolin K, Litchfield T, Akman S et al (1990) Prospective randomized comparison of fluorouracil versus fluorouracil and high-dose continuous infusion leucovorin calcium for the treatment of advanced measurable colorectal cancer in patients previously unexposed to chemotherapy. J Clin Oncol 8:491–501
Scheithauer W, Rosen H, Komek GV, Sebesta C, Depisch D (1993) Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ 306:752–755
Cunningham D, Pyrhonen S, James RD, Punt CJ, Hickish TF, Heikkila R et al (1998) Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 352:1413–1418
Acknowledgements
These findings were presented at the 18th World Congress of the International Society of Digestive Surgery held in Hong Kong in December 2002.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Law, W.L., Chan, W.F., Lee, Y.M. et al. Non-curative surgery for colorectal cancer: critical appraisal of outcomes. Int J Colorectal Dis 19, 197–202 (2004). https://doi.org/10.1007/s00384-003-0551-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-003-0551-7