title: Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases.
abstract: BACKGROUND
  The role of palliative resection of the primary tumour in patients who present with metastatic colorectal cancer is unclear.
  
  
  OBJECTIVE
  This study compared the incidence of major intestinal complications in such patients who received chemotherapy treatment with or without prior palliative resection of the primary tumour.
  
  
  METHODS
  The incidence of intestinal obstruction, perforation, fistula formation, and gastrointestinal haemorrhage, and the requirement for abdominal radiotherapy in patients with metastatic colorectal cancer treated at a single institution over a 10 year period was determined.
  
  
  RESULTS
  Eighty two patients received initial treatment with chemotherapy without resection of the primary tumour (unresected group) and 280 patients had undergone prior resection (resected group). In the unresected group, the incidence of peritonitis, fistula formation, and intestinal haemorrhage was 2.4% (95% confidence interval (CI) 0.3-8.5%), 3.7% (95% CI 0.8-10.3%), and 3.7% (95% CI 0.8-10.3%), respectively, and was not significantly different from the resected group. Intestinal obstruction affected 13.4% (95% CI 6.9-22.7%) of patients in the unresected group and 13.2% (95% CI 9.2-17.2%) of patients in the resected group. More patients in the unresected group required >/=3 blood transfusions (14.6% v 7.5%; p=0.048) and abdominal radiotherapy (18.3% v 9.6%; p=0.03) than the resected group.
  
  
  CONCLUSIONS
  The incidence of major intestinal complications in patients with unresected colorectal cancer and synchronous metastases who receive initial treatment with chemotherapy is low. Chemotherapy may be successfully used as initial treatment for such patients with no increased risk of most major intestinal complications compared with patients who have undergone initial resection of the primary tumour.
authors.affiliation: Gastrointestinal Unit, Royal Marsden Hospital, London and Surrey, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Tebbutt
authors.forename: A R
authors.initials: AR
authors.lastname: Norman
authors.forename: D
authors.initials: D
authors.lastname: Cunningham
authors.forename: M E
authors.initials: ME
authors.lastname: Hill
authors.forename: D
authors.initials: D
authors.lastname: Tait
authors.forename: J
authors.initials: J
authors.lastname: Oates
authors.forename: S
authors.initials: S
authors.lastname: Livingston
authors.forename: J
authors.initials: J
authors.lastname: Andreyev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006801:Humans; D007410:Intestinal Diseases / Q000139:chemically induced; D007415:Intestinal Obstruction / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis