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Oncological benefit of primary tumor resection with high tie lymph node dissection in unresectable colorectal cancer with synchronous peritoneal metastasis: a propensity score analysis of data from a multi-institute database

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Abstract

Background

Peritoneal metastasis is recognized as a predictor of poor prognosis in patients with colorectal cancer, and whether surgical intervention for peritoneal metastasis has any clinical benefit has remained controversial. The purposes of this study were to identify prognostic factors in cases of unresectable colorectal cancer with synchronous peritoneal metastasis and to clarify the impacts of primary tumor resection with high tie lymph node dissection.

Methods

A multi-institutional retrospective analysis was conducted of 579 patients who underwent resection of the primary tumor for unresectable colorectal cancer with peritoneal metastasis between 1991 and 2007. For these 579 patients, clinicopathological variables were analyzed for prognostic significance using Cox proportional hazards model and propensity score analysis to mitigate the selection bias.

Results

Multivariate analysis revealed hematogenous metastasis (p < 0.001), histology of the tumor (p = 0.006), postoperative chemotherapy (p < 0.001), and lymph node dissection (p = 0.001) as independent prognostic factors. In the propensity-matched cohort, patients treated with high tie lymph node dissection showed a significantly better overall survival than those with low tie lymph node dissection (median overall survival 13.0 vs. 11.5 months; p = 0.041).

Conclusions

It is suggested that primary tumor resection with high tie lymph node dissection favorably affects survival, even in unresectable colorectal cancer with peritoneal metastasis.

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Acknowledgments

The authors would like to express their sincere gratitude to the following researchers for collecting data: Kimihiko Funahashi, MD, Department of Surgery, Toho University; Kazuo Hase, MD, Department of Surgery, National Defense Medical College; Yojiro Hashiguchi, MD, Department of Surgery, Teikyo University; Tsuneo Iiai, MD, Department of Surgery, Niigata University; Shingo Kameoka, MD, Second Department of Surgery, Tokyo Women’s Medical University; Yukihide Kanemitsu, MD, and Koji Komori, MD, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital; Koutarou Maeda, MD, Department of Surgery, Fujita Health University; Akihiko Murata, MD, Department of Surgery, Hirosaki University; Masayuki Ohue, MD, Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases; Kazuo Shirouzu, MD, Department of Surgery, Kurume University, Keiichi Takahashi, MD, Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital; Toshiaki Watanabe, MD, Department of Surgical Oncology, University of Tokyo; Hideaki Yano, MD, Department of Surgery, National Center for Global Health and Medicine; and Toshimasa Yatsuoka, MD, Department of Surgery, Saitama Cancer Center.

Conflict of interest

All authors declare that they have no conflict of interest in this manuscript.

Author information

Authors and Affiliations

  1. Department of Nursing, Sapporo Medical University, South 1, West 17, Chuo-ku, Sapporo, Japan

    Tomohisa Furuhata

  2. Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan

    Kenji Okita, Toshihiko Nishidate & Koichi Hirata

  3. Department of Public Health, Sapporo Medical University, Sapporo, Japan

    Hirofumi Ohnishi

  4. Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan

    Hirotoshi Kobayashi & Kenichi Sugihara

  5. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan

    Kenjiro Kotake

Authors
  1. Tomohisa Furuhata
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  2. Kenji Okita
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  3. Toshihiko Nishidate
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  4. Koichi Hirata
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  5. Hirofumi Ohnishi
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  6. Hirotoshi Kobayashi
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  7. Kenjiro Kotake
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  8. Kenichi Sugihara
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Consortia

Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum

Corresponding author

Correspondence to Tomohisa Furuhata.

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Furuhata, T., Okita, K., Nishidate, T. et al. Oncological benefit of primary tumor resection with high tie lymph node dissection in unresectable colorectal cancer with synchronous peritoneal metastasis: a propensity score analysis of data from a multi-institute database. Int J Clin Oncol 20, 922–927 (2015). https://doi.org/10.1007/s10147-015-0815-6

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  • DOI: https://doi.org/10.1007/s10147-015-0815-6

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