Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease Journal Article

Authors: Nash, G. M.; Saltz, L. B.; Kemeny, N. E.; Minsky, B.; Sharma, S.; Schwartz, G. K.; Ilson, D. H.; O'reilly, E.; Kelsen, D. P.; Nathanson, D. R.; Weiser, M.; Guillem, J. G.; Douglas Wong, W.; Cohen, A. M.; Paty, P. B.
Article Title: Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease
Abstract: Background: The optimal use of radical surgery to palliate primary rectal cancers presenting with synchronous distant metastases is poorly defined. We have reviewed stage IV rectal cancer patients to evaluate the effectiveness of radical surgery without radiation as local therapy. Methods: Eighty stage IV patients with resectable primary rectal tumors treated with radical rectal surgery without radiotherapy were identified. Sixty-one (76%) patients received chemotherapy; response information was available for 34 patients. Results: Radical resection was accomplished by low anterior resection (n = 65), abdominoperineal resection (n = 11), and Hartmann's resection (n = 4). Surgical complications were seen in 12 patients (15%), with 1 death and 4 reoperations. The local recurrence rate was 6% (n = 5), with a median time to local recurrence of 14 months. Only one patient received pelvic radiotherapy as salvage treatment. One patient required subsequent diverting colostomy. Median survival was 25 months. On multivariate analysis, the extent of metastasis and response to chemotherapy were determinants of prolonged survival. Conclusions: For patients who present with distant metastases and resectable primary rectal cancers, radical surgery without radiotherapy can provide durable local control with acceptable morbidity. The extent of metastatic disease and the response to chemotherapy are the major determinants of survival. Effective systemic chemotherapy should be given high priority in the treatment of stage IV rectal cancer.
Keywords: adult; cancer chemotherapy; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; surgical technique; survival rate; retrospective studies; major clinical study; cancer recurrence; salvage therapy; fluorouracil; liver neoplasms; cancer radiotherapy; combined modality therapy; adenocarcinoma; palliative care; metastasis; neoplasm recurrence, local; antineoplastic combined chemotherapy protocols; distant metastasis; irinotecan; postoperative complication; survival time; folinic acid; medical record; reoperation; surgery; surgical mortality; new york city; multivariate analysis; regression analysis; rectum carcinoma; rectal neoplasms; rectum resection; rectal cancer; colostomy; stage iv; humans; human; male; female; article
Journal Title: Annals of Surgical Oncology
Volume: 9
Issue: 10
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2002-12-01
Start Page: 954
End Page: 960
Language: English
DOI: 10.1245/aso.2002.03.068
PUBMED: 12464586
PROVIDER: scopus
Notes: Export Date: 14 November 2014 -- Source: Scopus
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MSK Authors
  1. Leonard B Saltz
    620 Saltz
  2. Gary Schwartz
    370 Schwartz
  3. Philip B Paty
    380 Paty
  4. Bruce Minsky
    274 Minsky
  5. Sunil Sharma
    26 Sharma
  6. Jose Guillem
    380 Guillem
  7. Alfred M Cohen
    195 Cohen
  8. Martin R Weiser
    351 Weiser
  9. Garrett Nash
    141 Nash
  10. David H Ilson
    285 Ilson
  11. Eileen O'Reilly
    349 O'Reilly
  12. Douglas W Wong
    173 Wong
  13. David P Kelsen
    366 Kelsen
  14. Nancy Kemeny
    379 Kemeny