Skip to main content

Advertisement

SpringerLink
Log in

Impact of Primary Tumor Resection on Mortality in Patients with Stage IV Colorectal Cancer with Unresectable Metastases: A Multicenter Retrospective Cohort Study

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Primary tumor resection (PTR) before commencing systemic chemotherapy in patients with stage IV colorectal cancer and unresectable metastases (mCRC) remains controversial. This study aimed to assess whether PTR before systemic chemotherapy is associated with mortality in mCRC patients, after adjusting for confounding factors, such as the severity of the primary tumor and metastatic lesions.

Methods

We analyzed hospital-based cancer registries from nine designated cancer hospitals in Fukushima Prefecture, Japan. Patients were divided into two groups (PTR and non-PTR), based on whether PTR was performed as initial therapy for mCRC or not. The primary outcome was all-cause mortality. Kaplan–Meier survival analysis was performed, and survival estimates were compared using the log-rank test. Adjusted hazard ratios were calculated using Cox regression to adjust for confounding factors. All tests were two-sided; P-values < 0.05 were considered statistically significant.

Results

Between 2008 and 2015, 616 mCRC patients were included (PTR: 414 [67.2%]; non-PTR: 202 [32.8%]). The median follow-up time was 18.0 (interquartile range [IQR]: 8.4–29.7) months, and 492 patients (79.9%) died during the study period. Median overall survival in the PTR and non-PTR groups was 23.9 (IQR: 12.2–39.9) and 12.3 (IQR: 6.2–23.8) months, respectively (P < 0.001, log-rank test). PTR was significantly associated with improved overall survival (adjusted hazard ratio: 0.51; 95% confidence interval: 0.42–0.64, P < 0.001).

Conclusions

PTR before systemic chemotherapy in patients with mCRC was associated with improved survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Article  Google Scholar 

  2. Miller KD, Siegel RL, Lin CC et al (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66:271–289

    Article  Google Scholar 

  3. Hori M, Matsuda T, Shibata A et al (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the monitoring of cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol 45:884–891

    Article  Google Scholar 

  4. de Haas RJ, Wicherts DA, Andreani P et al (2011) Impact of expanding criteria for resectability of colorectal metastases on short- and long-term outcomes after hepatic resection. Ann Surg 253:1069–1079

    Article  Google Scholar 

  5. Van Cutsem E, Cervantes A, Adam R et al (2016) ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 27:1386–1422

    Article  Google Scholar 

  6. Ruo L, Gougoutas C, Paty PB et al (2003) Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 196:722–728

    Article  Google Scholar 

  7. Cummins ER, Vick KD, Poole GV (2004) Incurable colorectal carcinoma: the role of surgical palliation. Am Surg 70:433–437

    PubMed  Google Scholar 

  8. Benoist S, Pautrat K, Mitry E et al (2005) Treatment strategy for patients with colorectal cancer and synchronous irresectable liver metastases. Br J Surg 92:1155–1160

    Article  CAS  Google Scholar 

  9. Poultsides GA, Servais EL, Saltz LB et al (2009) Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 27:3379–3384

    Article  Google Scholar 

  10. Kim CW, Baek JH, Choi GS et al (2016) The role of primary tumor resection in colorectal cancer patients with asymptomatic, synchronous unresectable metastasis: study protocol for a randomized controlled trial. Trials 17:34

    Article  Google Scholar 

  11. Biondo S, Frago R, Kreisler E et al (2017) Impact of resection versus no resection of the primary tumor on survival in patients with colorectal cancer and synchronous unresectable metastases: protocol for a randomized multicenter study (CR4). Int J Colorectal Dis 32:1085–1090

    Article  Google Scholar 

  12. Cotte E, Villeneuve L, Passot G et al (2015) GRECCAR 8: impact on survival of the primary tumor resection in rectal cancer with unresectable synchronous metastasis: a randomized multicentre study. BMC Cancer 15:47

    Article  Google Scholar 

  13. Rahbari NN, Lordick F, Fink C et al (2012) Resection of the primary tumour versus no resection prior to systemic therapy in patients with colon cancer and synchronous unresectable metastases (UICC stage IV): SYNCHRONOUS–a randomised controlled multicentre trial (ISRCTN30964555). BMC Cancer 12:142

    Article  Google Scholar 

  14. t Lam-Boer J, Mol L, Verhoef C et al (2014) The CAIRO4 study: the role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer–a randomized phase III study of the dutch colorectal cancer group (DCCG). BMC Cancer 14:741

    Article  Google Scholar 

  15. Moritani K, Kanemitsu Y, Shida D et al (2019) A randomized controlled trial comparing primary tumour resection plus chemotherapy with chemotherapy alone in incurable stage IV colorectal cancer: JCOG1007 (iPACS study). Jpn J Clin Oncol 50(1):89–93

    Article  Google Scholar 

  16. Ishihara S, Nishikawa T, Tanaka T et al (2015) Benefit of primary tumor resection in stage IV colorectal cancer with unresectable metastasis: a multicenter retrospective study using a propensity score analysis. Int J Colorectal Dis 30:807–812

    Article  Google Scholar 

  17. van Rooijen KL, Shi Q, Goey KKH et al (2018) Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: individual patient data analysis of first-line randomised trials from the ARCAD database. Eur J Cancer 91:99–106

    Article  Google Scholar 

  18. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  Google Scholar 

  19. Shah S, Vanclay F, Cooper B (1989) Improving the sensitivity of the Barthel index for stroke rehabilitation. J Clin Epidemiol 42:703–709

    Article  CAS  Google Scholar 

  20. Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–74

    Article  Google Scholar 

  21. Japanese Society for Cancer of the C, Rectum (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3d edition [secondary publication]. J Anus Rectum Colon 3:175–195

    Article  Google Scholar 

  22. Rubin DB (1987) Multiple imputation for nonresponse in surveys. John Wiley and Sons, New York

    Book  Google Scholar 

  23. Recondo G Jr, Díaz-Cantón E, de la Vega M et al (2014) Advances and new perspectives in the treatment of metastatic colon cancer. World J Gastrointest Oncol 6:211–224

    Article  Google Scholar 

  24. ‘t Lam-Boer J, Van der Geest LG, Verhoef C et al (2016) Palliative resection of the primary tumor is associated with improved overall survival in incurable stage IV colorectal cancer: a nationwide population-based propensity-score adjusted study in the Netherlands. Int J Cancer 139:2082–2094

    Article  Google Scholar 

  25. Kakeji Y, Takahashi A, Udagawa H et al (2018) Surgical outcomes in gastroenterological surgery in Japan: report of national clinical database 2011–2016. Ann Gastroenterol Surg 2:37–54

    Article  Google Scholar 

  26. van Leersum NJ, Aalbers AG, Snijders HS et al (2014) Synchronous colorectal carcinoma: a risk factor in colorectal cancer surgery. Dis Colon Rectum 57:460–466

    Article  Google Scholar 

  27. Lemmens VE, Klaver YL, Verwaal VJ et al (2011) Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: a population-based study. Int J Cancer 128:2717–2725

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to express our gratitude to Seria Sato, Koji Uehara, Nobuko Kanno, Mika Yusa, Kazuhira Saito, Tomoko Oya, Yosinobu Yamazaki, Yoko Endo, Chieko Tairako, Yumi Inaba for their contribution to data collection.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida‐Konoe‐cho, Sakyo, Kyoto, 606‐8501, Japan

    Hidetaka Kawamura, Yusuke Ogawa, Hajime Yamazaki, Shunichi Fukuhara & Yosuke Yamamoto

  2. Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Koriyama, Japan

    Hidetaka Kawamura & Michitaka Honda

  3. Department of Surgical Oncology, Southern Tohoku General Hospital, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan

    Hidetaka Kawamura & Michitaka Honda

  4. Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Hajime Yamazaki & Shunichi Fukuhara

  5. Department of Gastrointestinal Tract Surgery, Fukushima Medical University, Fukushima, Fukushima, Japan

    Koji Kono

  6. Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, Japan

    Shinichi Konno

Authors
  1. Hidetaka Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hajime Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michitaka Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koji Kono
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinichi Konno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shunichi Fukuhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yosuke Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hidetaka Kawamura.

Ethics declarations

Ethical statement

The study was conducted in accordance with the Declaration of Helsinki and relevant local laws and regulations. The study protocol was approved by the institutional review board of all participating hospitals (UMIN000033718).

Informed consent

The institutional review board waived the requirement for informed consent in accordance with the Japanese government’s Ethical Guidelines for Medical and Health Research Involving Human Subjects, which allow for the opt-out approach.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (XLSX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawamura, H., Ogawa, Y., Yamazaki, H. et al. Impact of Primary Tumor Resection on Mortality in Patients with Stage IV Colorectal Cancer with Unresectable Metastases: A Multicenter Retrospective Cohort Study. World J Surg 45, 3230–3239 (2021). https://doi.org/10.1007/s00268-021-06233-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-021-06233-x

Search

Navigation