Synapse - Primary tumor-related complications and salvage outcomes in patients with metastatic rectal cancer and an untreated primary tumor

Primary tumor-related complications and salvage outcomes in patients with metastatic rectal cancer and an untreated primary tumor Journal Article

Authors:	Tan, W. J.; Patil, S.; Guillem, J. G.; Paty, P. B.; Weiser, M. R.; Nash, G. M.; Smith, J. J.; Pappou, E. P.; Wei, I. H.; Garcia-Aguilar, J.
Article Title:	Primary tumor-related complications and salvage outcomes in patients with metastatic rectal cancer and an untreated primary tumor
Abstract:	BACKGROUND: For rectal cancer with unresectable metastases, current practice favors omitting interventions directed at the primary tumor in asymptomatic patients. OBJECTIVE: This study aimed to determine the proportion of patients with primary tumor-related complications, characterize salvage outcomes, and measure survival in patients with metastatic rectal cancer who did not undergo upfront intervention for their primary tumor. DESIGN: This is a retrospective analysis. SETTING: This study was conducted at a comprehensive cancer center. PATIENTS: Patients who presented between January 1, 2008, and December 31, 2015, with synchronous stage IV rectal cancer, an unresected primary tumor, and no prior primary tumor-directed intervention were selected. MAIN OUTCOME MEASURES: The main outcome measured was the rate of primary tumor-related complications in the cohort that did not receive any primary tumordirected intervention. The Kaplan-Meier method and Cox regression analysis were used to determine whether complications are associated with survival. RESULTS: The cohort comprised 358 patients with a median age of 56 years (22-92). Median follow-up was 26 months (range, 1-93 months). Among the 168 patients (46.9%) who eventually underwent elective resection of the primary tumor, the surgery was performed with curative intent in 66 patients (18.4%) and preemptive intent in 102 patients (28.5%). Of the 190 patients who did not undergo an upfront or elective intervention for the primary tumor, 68 (35.8%) experienced complications. Nonsurgical intervention for complications was attempted in 34 patients with an overall success rate of 61.8% (21/34). Surgical intervention was performed in 47 patients (including 13 patients for whom nonsurgical intervention failed): diversion in 26 patients and resection in 21 patients. Of those 47 patients, 42 (89.4%) ended up with a colostomy or ileostomy. LIMITATIONS: This study was conducted at a single center. CONCLUSION: A significant proportion of patients with metastatic rectal cancer and untreated primary tumor experience primary tumor-related complications. These patients should be followed closely, and preemptive intervention (resection, diversion, or radiation) should be considered if the primary tumor progresses despite systemic therapy. See Video Abstract at http://links.lww. com/DCR/B400.
Keywords:	survival; metastasis; surgery; complications; resection; tumor; salvage; colon; therapy; rectal cancer; metaanalysis; receiving chemotherapy; iv colorectal-cancer; untreated primary
Journal Title:	Diseases of the Colon and Rectum
Volume:	64
Issue:	1
ISSN:	0012-3706
Publisher:	Lippincott Williams & Wilkins
Date Published:	2021-01-01
Start Page:	45
End Page:	52
Language:	English
ACCESSION:	WOS:000598229300017
DOI:	10.1097/dcr.0000000000001803
PROVIDER:	wos
PUBMED:	33306531
PMCID:	PMC7931667
Notes:	Article -- Source: Wos