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Outcomes of resection of stage IV rectal cancer with mesorectal excision
Author(s) -
Law Wai Lun,
Chu Kin Wah
Publication year - 2006
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.20506
Subject(s) - medicine , abdominoperineal resection , colorectal cancer , surgery , stage (stratigraphy) , total mesorectal excision , univariate analysis , cancer , metastasis , multivariate analysis , t stage , survival rate , rectum , overall survival , paleontology , biology
Background There is no consensus as to the management of the primary rectal cancer in the presence of distant metastasis and data on the outcomes of radical resection in stage IV rectal cancer are limited. This study aims to evaluate the results of resection of rectal cancer in the patients with stage IV disease and to analyze the factors that might affect the survival of these patients. Methods Of the 744 patients with radical resection of primary rectal and rectosigmoid cancer during the study period from August 1993 to July 2002, 70 had stage IV disease on the initial presentation. The demographics, the operative details, the tumor characteristics, the postoperative outcomes and survival of the patients were collected prospectively. Factors influencing the survival were analyzed with univariate and multivariate analysis. Results Fifty‐three men and 17 women with a median age of 66 years (range: 31–90 years) were included. The median level of the tumor from the anal verge was 10 cm (range 3–20 cm). The operations included abdominoperineal resection (n = 5), anterior resection (n = 53), and Hartmanns operation (n = 11). The operation mortality was 4.3%. The overall morbidity was 42.7% while the surgical morbidity and the reoperation rates were 15.7% and 5%, respectively. The local recurrence rate was 4.3% and the 2‐year actuarial rate was 7.8%. All the patients who had local recurrences also had disseminated peritoneal metastasis. The median cancer‐specific survival of the patients who survived the surgery was 15.2 months. Multivariate analysis showed that the presence of gross residual local disease, lymph node metastasis, liver involvement of over 50%, the absence of surgical management of liver metastasis and those without chemotherapy were independent factors associated with poor survival. Conclusions Postoperative mortality and morbidity were acceptable in patients with stage IV rectal cancer. The local disease can be controlled effectively with radical resection. However, in patients with extensive liver involvement and advanced local disease, resection is not worthwhile because of the poor survival. Surgical management of the metastasis and the administration of chemotherapy are associated with better survival. However, the optional treatment regimes are yet to be defined. J. Surg. Oncol. 2006;93:523–528. © 2006 Wiley‐Liss, Inc.