Non-curative surgery for colorectal cancer: critical appraisal of outcomes.
OBJECTIVE
The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery.


METHODS
Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative resection was performed in 150 cases. Seventeen patients died in the postoperative period. Risk factors for postoperative mortality and poor survival were analysed with univariate and multivariate analysis.


RESULTS
Multivariate analysis showed that operative mortality was significantly higher in patients with non-resection surgery and in those with ascites. Median survival of patients with resection was significantly longer than in those without resection (30 vs. 17 weeks). Other independent factors that were significantly associated poor survival were the presence of ascites, presence of bilobar liver metastasis and absence of chemotherapy and/or radiation therapy.


CONCLUSIONS
Non-curative surgery is associated with high mortality in patients without resection and in the presence of ascites. These two factors, together with the presence of bilobar liver metastasis and the absence of chemotherapy and/or radiation therapy, are associated with poor survival. In the presence of these factors the balance between the benefit and risk of surgery should be carefully considered before decision for operative treatment.
Law
Wai Lun
WL
Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Pokfulam Road, Hong Kong, China. lawwl@hkucc.hku.hk
Chan
Wai Fun
WF
Lee
Yee Man
YM
Chu
Kin Wah
KW
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000150:complications; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis