Shinobu Ohnuma, MD, PhD, Hideaki Karasawa, MD, PhD, Kazuhiro Watanabe, MD, PhD, Akihiro Yamamura, MD, PhD, Hirofumi Imoto, MD, PhD, Atsushi Kohyama, MD, PhD, Takeshi Aoki, MD, PhD, Naoki Tanaka, MD, PhD, Hiroaki Musha, MD, PhD, Fuyuhiko Motoi, MD, PhD, Takashi Kamei, MD, PhD, Takeshi Naitoh, MD, PhD, Michiaki Unno, MD, PhD. Department of Surgery, Tohoku University Hospital
Introduction: The role of primary tumor removal in patients with stage IV colorectal cancer (CRC) is still controversial. We assessed the impact of primary tumor removal for patients with stage IV CRC, and evaluated the role of laparoscopic surgery for patients with stage IV CRC.
Materials & Methods: One hundred eighty-four patients (male: 105, female: 79, median age: 66 (26-91)) with stage IV CRC who had surgical treatments in Tohoku University Hospital from 2000 to 2017 were retrospectively analyzed. Survival analysis was conducted using Kaplan-Meier methods. The relationship between primary tumor removal and overall survival (OS) was evaluated by Cox-proportional hazards regression models with age, sex, CEA, primary tumor location, metastatic sites and number, metastasectomy, and receipt of systemic chemotherapy.
Results: Primary tumor was surgically removed in 147 (80%) patients (group A), however, palliative procedures, such as colostomy or bypass, were carried out in 37 (20%) patients (group B). Three and five-years survival rate were 49% and 25% for group A, 7% and 0% for group B, respectively (p<0.0001). Cox-proportional hazards regression models indicated that female (HR: 0.60, 95%CI: 0.41 – 0.89, p = 0.0096), primary tumor removal (HR: 0.32, 95%CI: 0.20 – 0.52, p<0.0001), and metastasectomy (HR: 0.26, 95%CI: 0.11 – 0.53, p<0.0001) were associated with improved survival with the patients with Stage IV CRC. In group A, primary tumor of 109 patients (74%) were removed with open-laparotomy (OPEN), on the other hand, that of 38 patients (26%) were laparoscopically removed (LAP). LAP group showed statistically shorter hospital-length of stay after surgery (11 vs 19 days, p<0.0001), and less blood-loss (38 vs 309 ml, p<0.0001). There was no difference in operative time between the two groups (LAP vs OPEN, 224 vs 214 ml, p=0.7535). Furthermore, LAP was associated with a longer survival compared to OPEN group; three and five-years survival rate: 62% and 40% vs 44% and 22%, respectively (p=0.0345).
Conclusion: Primary tumor removal may improve the outcome of patient with stage IV CRC. Less invasive laparoscopic approach may be beneficial for the patients with stage IV disease who need further immediate treatments for distant metastases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87645
Program Number: P286
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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