Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?

Aim: The need for resection of the primary tumour in stage IV minimally symptomatic rectal cancer (RC) is controversial. Method: An IRB‐approved cancer database and billing records were queried to identify stage IV rectal cancer patients with a minimally‐symptomatic primary tumour (no obstruction...

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Main Authors:	Faisal, Elagili, Stocchi, Luca, Kalady, Matthew F, Dietz, David
Format:	Article
Language:	English
Published:	Wiley-Blackwell 2014
Subjects:	RD Surgery
Online Access:	http://irep.iium.edu.my/69852/ http://irep.iium.edu.my/69852/ http://irep.iium.edu.my/69852/3/2014-Colorectal_Disease.pdf

id	iium-69852
recordtype	eprints
spelling	iium-698522019-04-16T07:13:53Z http://irep.iium.edu.my/69852/ Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected? Faisal, Elagili Stocchi, Luca Kalady, Matthew F Dietz, David RD Surgery Aim: The need for resection of the primary tumour in stage IV minimally symptomatic rectal cancer (RC) is controversial. Method: An IRB‐approved cancer database and billing records were queried to identify stage IV rectal cancer patients with a minimally‐symptomatic primary tumour (no obstruction, perforation, or massive bleeding) between 1980 and 2013. Patients who underwent initial resection of the primary tumour (Group I) were case‐matched with patients who underwent treatment without initial resection (Group II) according to age, sex, ASA classification, and number of organs involved with metastatic disease. Results: Ninety six patients were matched from a total cohort of 249 patients (215 Group I, 34 Group II) with stage IV RC. 54% were male and the mean age was 60.3 ± 11.2 years. Median survival times for Group I and Group II were 15 (range 11–20) and 20.5 (6–29) months respectively (P = 0.54). Within group I, 49 (73%) patients underwent anterior proctosigmoidectomy, 14 (21%) underwent abdominoperineal resection, 2 (3%) underwent Hartmann's procedure, and 2 (3%) underwent total proctocolectomy with end ileostomy. Treatment related mortality rate was 3% in Group I and 0% in Group II. In Group I, post operative morbidity rate was 48% (32 of 67 patients). In Group II, complications related to the unresected primary tumour occurred in 2 patients: acute bowel obstruction requiring endoscopic stenting (1) and rectovaginal fistula requiring stoma diversion (1). 4 patients in Group II required palliative radiotherapy during the course of treatment due to pelvic pain. The median number of in‐hospital days during the course of treatment was 10 (8–13) days in Group I and 1 (0–15) days in Group II (P < 0.001). Conclusion: In patients presenting with minimally symptomatic Stage IV RC, a treatment strategy of chemotherapy without resection of the primary tumour may minimize treatment‐related morbidity, mortality, and days spent in‐hospital without adversely affecting survival. This may have important implications for quality of life in these patients with limited life expectancy. Wiley-Blackwell 2014-07 Article PeerReviewed application/pdf en http://irep.iium.edu.my/69852/3/2014-Colorectal_Disease.pdf Faisal, Elagili and Stocchi, Luca and Kalady, Matthew F and Dietz, David (2014) Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected? Colorectal Disease, 16 (S2). p. 119. ISSN 1462-8910 E-ISSN 1463-1318 https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.12644_1
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RD Surgery
spellingShingle	RD Surgery Faisal, Elagili Stocchi, Luca Kalady, Matthew F Dietz, David Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?
description	Aim: The need for resection of the primary tumour in stage IV minimally symptomatic rectal cancer (RC) is controversial. Method: An IRB‐approved cancer database and billing records were queried to identify stage IV rectal cancer patients with a minimally‐symptomatic primary tumour (no obstruction, perforation, or massive bleeding) between 1980 and 2013. Patients who underwent initial resection of the primary tumour (Group I) were case‐matched with patients who underwent treatment without initial resection (Group II) according to age, sex, ASA classification, and number of organs involved with metastatic disease. Results: Ninety six patients were matched from a total cohort of 249 patients (215 Group I, 34 Group II) with stage IV RC. 54% were male and the mean age was 60.3 ± 11.2 years. Median survival times for Group I and Group II were 15 (range 11–20) and 20.5 (6–29) months respectively (P = 0.54). Within group I, 49 (73%) patients underwent anterior proctosigmoidectomy, 14 (21%) underwent abdominoperineal resection, 2 (3%) underwent Hartmann's procedure, and 2 (3%) underwent total proctocolectomy with end ileostomy. Treatment related mortality rate was 3% in Group I and 0% in Group II. In Group I, post operative morbidity rate was 48% (32 of 67 patients). In Group II, complications related to the unresected primary tumour occurred in 2 patients: acute bowel obstruction requiring endoscopic stenting (1) and rectovaginal fistula requiring stoma diversion (1). 4 patients in Group II required palliative radiotherapy during the course of treatment due to pelvic pain. The median number of in‐hospital days during the course of treatment was 10 (8–13) days in Group I and 1 (0–15) days in Group II (P < 0.001). Conclusion: In patients presenting with minimally symptomatic Stage IV RC, a treatment strategy of chemotherapy without resection of the primary tumour may minimize treatment‐related morbidity, mortality, and days spent in‐hospital without adversely affecting survival. This may have important implications for quality of life in these patients with limited life expectancy.
format	Article
author	Faisal, Elagili Stocchi, Luca Kalady, Matthew F Dietz, David
author_facet	Faisal, Elagili Stocchi, Luca Kalady, Matthew F Dietz, David
author_sort	Faisal, Elagili
title	Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?
title_short	Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?
title_full	Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?
title_fullStr	Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?
title_full_unstemmed	Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?
title_sort	management of asymptomatic stage iv rectal cancer: should the primary tumor be resected?
publisher	Wiley-Blackwell
publishDate	2014
url	http://irep.iium.edu.my/69852/ http://irep.iium.edu.my/69852/ http://irep.iium.edu.my/69852/3/2014-Colorectal_Disease.pdf
first_indexed	2023-09-18T21:39:10Z
last_indexed	2023-09-18T21:39:10Z
_version_	1777413023703498752

Management of asymptomatic stage IV rectal cancer: should the primary tumor be resected?

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