Nonoperative management of the primary tumor in patients with unresectable stage IV colon cancer treated with systemic chemotherapy: Higher complication rates for left-sided colon tumors Journal Article
| Authors: | Verheij, F. S.; Yuval, J. B.; Kok, N. F. M.; Lin, S. T.; Qin, L. X.; Omer, D. M.; Thompson, H. M.; Wei, I. H.; Widmar, M.; Pappou, E. P.; Weiser, M. R.; Nash, G. M.; Smith, J. J.; Paty, P. B.; Beets, G. L.; Garcia-Aguilar, J. |
| Article Title: | Nonoperative management of the primary tumor in patients with unresectable stage IV colon cancer treated with systemic chemotherapy: Higher complication rates for left-sided colon tumors |
| Abstract: | Introduction: Treatment of the primary tumor in asymptomatic patients with unresectable colorectal metastases remains controversial. Methods: Data from patients with synchronous stage IV colon cancer and an untreated primary tumor who started treatment aimed at metastatic disease at a specialized cancer center between 2014 and 2018 were analyzed retrospectively. Main outcome was primary tumor-related complications comparing left-sided and right-sided colon cancer. A competing-risk regression model was used to identify predictors of complications. Results: Of 523 patients with metastatic colon cancer at presentation, 221 started treatment aimed at metastatic disease; these patients constituted the study cohort. The primary tumor was left-sided in 109 patients (49%) and right-sided in 112 patients (51%). In total, 46 patients (21%) developed a complication that required invasive intervention. Complications occurred more frequently in patients with left-sided tumors than in patients with right-sided tumors (29% vs 13%, P = 0.003). Eighteen patients (8%) underwent non-surgical intervention. Six patients (33%) failed non-surgical management and underwent surgery. Of 34 patients (15%) who underwent surgical intervention, 20 underwent an emergency colectomy and 14 underwent diversion with a permanent stoma. Overall, 10% of patients ended up with a permanent stoma. In competing-risk analysis, only left-sided primary tumor (hazard ratio 2.62; 95% CI 1.40–4.89; P = 0.003) was significantly associated with primary tumor-related complications requiring invasive intervention. Conclusions: Patients with asymptomatic metastatic left-sided tumors have a higher risk for primary tumor-related complications than patients with right-sided tumors. Close monitoring and early surgical rescue should be considered for patients with left-sided colon cancer who are managed nonoperatively. © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology |
| Keywords: | adult; cancer chemotherapy; cancer survival; human tissue; aged; primary tumor; unclassified drug; major clinical study; overall survival; fluorouracil; systemic therapy; follow up; metastasis; carcinoembryonic antigen; protein; cohort analysis; cancer pain; retrospective study; histology; risk assessment; irinotecan; pneumonia; cancer center; lung metastasis; albumin; conservative treatment; folinic acid; microsatellite instability; complications; ras protein; clostridium difficile infection; colon perforation; inoperable cancer; intestine obstruction; oxaliplatin; fluoropyrimidine; colon adenocarcinoma; b raf kinase; apc protein; cecum; colectomy; cumulative incidence; hematochezia; abscess; smad4 protein; clinical outcome; septic shock; colon obstruction; first-line treatment; sigmoid; metastatic colon cancer; ascending colon; transverse colon; emergency surgery; intestine fistula; human; male; female; article; descending colon; pik3ca protein; colon stoma; splenic flexure; regression model; surgical intervention; non-surgical intervention; stage iv colon cancer; left sided colon cancer; right sided colon cancer |
| Journal Title: | European Journal of Surgical Oncology |
| Volume: | 50 |
| Issue: | 1 |
| ISSN: | 0748-7983 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-01-01 |
| Start Page: | 107294 |
| Language: | English |
| DOI: | 10.1016/j.ejso.2023.107294 |
| PUBMED: | 38039906 |
| PROVIDER: | scopus |
| PMCID: | PMC10841609 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Julio Garcia-Aguilar -- Source: Scopus |
