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Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The benefit of elective primary tumor resection for non-curable stage IV colorectal cancer (CRC) remains largely undefined. We wanted to identify risk factors for postoperative complications and short survival.

Methods

Using a prospective database, we analyzed potential risk factors in 233 patients, who were electively operated for non-curable stage IV CRC between 1996 and 2002. Patients with recurrent tumors, resectable metastases, emergency operations, and non-resective surgery were excluded. Risk factors for increased postoperative morbidity and limited postoperative survival were identified by multivariate analyses.

Results

Patients with colon cancer (CC = 156) and rectal cancer (RC = 77) were comparable with regard to age, sex, comorbidity, American Society of Anesthesiologists score, carcinoembryonic antigen levels, hepatic spread, tumor grade, resection margins, 30-day mortality (CC 5.1%, RC 3.9%) and postoperative chemotherapy. pT4 tumors, carcinomatosis, and non-anatomical resections were more common in colon cancer patients, whereas enterostomies (CC 1.3%, RC 67.5%, p < 0.0001), anastomotic leaks (CC 7.7%, RC 24.2%, p = 0.002), and total surgical complications (CC 19.9%, RC 40.3%, p = 0.001) were more frequent after rectal surgery. Independent determinants of an increased postoperative morbidity were primary rectal cancer, hepatic tumor load >50%, and comorbidity >1 organ. Prognostic factors for limited postoperative survival were hepatic tumor load >50%, pT4 tumors, lymphatic spread, R1–2 resection, and lack of chemotherapy.

Conclusions

Palliative resection is associated with a particularly unfavorable outcome in rectal cancer patients presenting with a locally advanced tumor (pT4, expected R2 resection) or an extensive comorbidity, and in all CRC patients who show a hepatic tumor load >50%. For such patients, surgery might be contraindicated unless the tumor is immediately life-threatening.

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Acknowledgments

The authors would like to thank Hans-Martin Hornung for data acquisition and management and Wolfgang H. Hartl for helpful discussion and critical revision of the manuscript (both from the Department of Surgery, University of Munich).

Conflict of interest statement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Klinikum Grosshadern, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany

    Axel Kleespies, Kathrin E. Füessl, Hendrik Seeliger, Martin E. Eichhorn, Mario H. Müller, Markus Rentsch, Wolfgang E. Thasler, Martin K. Angele, Martin E. Kreis & Karl-Walter Jauch

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  1. Axel Kleespies
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  2. Kathrin E. Füessl
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Correspondence to Axel Kleespies.

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Neither one of the authors nor the institutions from which the work originated have asked for, accepted, or received any direct or indirect financial support from a third party regarding the matter and materials discussed in this paper.

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Kleespies, A., Füessl, K.E., Seeliger, H. et al. Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorectal Dis 24, 1097–1109 (2009). https://doi.org/10.1007/s00384-009-0734-y

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