Clinical outcome of up-front surgery in patients with asymptomatic, incurable synchronous peritoneal carcinomatosis

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• 作者：Kenji Matsuda (1)
  Tsukasa Hotta (1)
  Katsunari Takifuji (1)
  Shozo Yokoyama (1)
  Yoshimasa Oku (1)
  Tadamichi Hashimoto (1)
  Hiromitsu Iwamoto (1)
  Hiroki Yamaue (1)
  
• 关键词：Up ; front surgery ; Asymptomatic colorectal cancer ; Peritoneal carcinomatosis ; Second Department of Surgery ; Wakayama Medical University ; School of Medicine ; Wakayama ; Japan
• 刊名：Surgery Today
• 出版年：2013
• 出版时间：September 2013
• 年：2013
• 卷：43
• 期：9
• 页码：984-989
• 全文大小：304KB
• 参考文献：1. Japanese Society for Cancer of the Colon and Rectum. Multi-Institutional Registry of Large Bowel Cancer in Japan. 2008;vol. 28. Cases treated in 1999.
  2. Lemments V, Klaver Y, Verwaal V, Rutten HJ, Coebergh JWW, Hingh IH. Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: a population-based study. Int J Cancer. 2010;128:2717-5. CrossRef
  3. Matsuda K, Hotta T, Takifuji K, Kobayashi Y, Tsuji T, Nagai Y, et al. Lymph node ratio is associated with the survival of colorectal cancer with peritoneal carcinomatosis. Am Surg. 2011;77(5):602-.
  4. Matsuda K, Hotta T, Takifuji K, Yamamoto M, Nasu T, Togo N, et al. Clinical impact of macroscopically complete resection of colorectal cancer with peritoneal carcinomatosis. Surgery. 2012;151:238-4. CrossRef
  5. Scheer M, Sloots C, Wilt J, Ruers J. Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases. Ann Oncol. 2008;19:1829-5. CrossRef
  6. Elias D, Gilly F, Boutitie F, Quenet F, Bereder JM, Mansvelt B, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63-. CrossRef
  7. Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89:1545-0. CrossRef
  8. Poultsides G, Servais E, Saltz L, Patil S, Kemeny N, Guillem J, et al. Outcomes of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol. 2009;27:3379-4. CrossRef
  9. Scoggins C, Meszoely I, Blanke C, Beauchamp D, Leach S. Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol. 1999;6(7):651-. CrossRef
  10. Sarela A, Guthrie J, Seymour M, Ride E, Guillou P, O’Riordain D. Non-operative management of the primary tumour in patients with incurable stage IV colorectal cancer. Br J Surg. 2001;88:1352-. CrossRef
  11. Tebbut N, Norman A, Cunningham D, Hill M, Tait D, Oates J, et al. Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases. Gut. 2003;52:568-3. CrossRef
  12. Clements D, Rao P, Ramanathan D, Adams R, Maughan T, Davies M. Management of the asymptomatic primary in the palliative treatment of metastatic colorectal cancer. Colorectal Dis. 2009;11:845-. CrossRef
  13. Stelzner S, Hellmich G, Koch R, Ludwig K. Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis. J Surg Oncol. 2005;89:211-. CrossRef
  14. Ruo L, Gougoutas C, Paty P, Guillem J, Cohen A, Wong D. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg. 2003;196:722-. CrossRef
  15. Galizia G, Lieto E, Orditura M, Castellano P, Imperatore V, Pinto M, et al. First-line chemotherapy vs bowel tumor resection plus chemotherapy for patients with unresectable synchronous colorectal hepatic metastases. Arch Surg. 2008;143(4):352-. CrossRef
  16. Stillwell A, Buettner P, Ho Y-H. Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone. World J Surg. 2010;34:797-07. CrossRef
  17. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma, 2nd ed. Tokyo: Kanehara & Co., Ltd.; 2009.
  18. McCahill LE, Yothers GA, Sharif S, Petrelli NJ, Lopa S, O’Connell MJ, et al. A Phase II trial of 5-fluorouracil, leucovorin and oxaliplatin (mFOLFOX6) chemotherapy plus bevacizumab (bev) for patients (pts) with unresectable stage IV colon cancer and a synchronous asymptomatic primary tumor: result of NSABP C-10. Proc Am Soc Clin Oncol. 2010;Abstr 3527.
  
• 作者单位：Kenji Matsuda (1)
  Tsukasa Hotta (1)
  Katsunari Takifuji (1)
  Shozo Yokoyama (1)
  Yoshimasa Oku (1)
  Tadamichi Hashimoto (1)
  Hiromitsu Iwamoto (1)
  Hiroki Yamaue (1)
  
  1. Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan
  

文摘

Purposes The purpose of this study was to show the clinical features of up-front surgery of the primary tumor in asymptomatic patients with incurable colorectal PC. Methods Forty-six patients that were diagnosed between 1998 and 2007 with asymptomatic colorectal PC who could not be successfully cured by surgery were assessed retrospectively. Results A univariate analysis revealed the presence of liver metastases, without the use of oxaliplatin (OX)/irinotecan (IRI) and without a primary tumor resection to be poor prognostic factors for survival (p?=?0.044, p?=?0.030, p?<?0.001, respectively). According to a multivariate analysis, no use of OX/IRI and no primary tumor resection, were found to be independent poor prognostic factors for survival (HR 2.57; p?=?0.047, HR 6.62; p?=?0.003, respectively). The median survival time of patients treated with and without OX/IRI was 18 and 7?months, respectively. The median survival time of patients with and without primary tumor resection was 10 and 2?months, respectively. The number of patients needing surgical intervention for intestinal obstruction after surgery significantly increased in patients treated with OX/IRI (p?=?0.001). Conclusion Improvement of survival may be related to widespread use of modern systemic chemotherapy and primary tumor resection. However, an increased number of patients that needed surgery for an intestinal obstruction were observed, even after up-front surgery, when patients were treated with modern systemic chemotherapy.