title: Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer.
abstract: OBJECTIVE
  The benefit of elective primary tumor resection for non-curable stage IV colorectal cancer (CRC) remains largely undefined. We wanted to identify risk factors for postoperative complications and short survival.
  
  
  METHODS
  Using a prospective database, we analyzed potential risk factors in 233 patients, who were electively operated for non-curable stage IV CRC between 1996 and 2002. Patients with recurrent tumors, resectable metastases, emergency operations, and non-resective surgery were excluded. Risk factors for increased postoperative morbidity and limited postoperative survival were identified by multivariate analyses.
  
  
  RESULTS
  Patients with colon cancer (CC = 156) and rectal cancer (RC = 77) were comparable with regard to age, sex, comorbidity, American Society of Anesthesiologists score, carcinoembryonic antigen levels, hepatic spread, tumor grade, resection margins, 30-day mortality (CC 5.1%, RC 3.9%) and postoperative chemotherapy. pT4 tumors, carcinomatosis, and non-anatomical resections were more common in colon cancer patients, whereas enterostomies (CC 1.3%, RC 67.5%, p < 0.0001), anastomotic leaks (CC 7.7%, RC 24.2%, p = 0.002), and total surgical complications (CC 19.9%, RC 40.3%, p = 0.001) were more frequent after rectal surgery. Independent determinants of an increased postoperative morbidity were primary rectal cancer, hepatic tumor load >50%, and comorbidity >1 organ. Prognostic factors for limited postoperative survival were hepatic tumor load >50%, pT4 tumors, lymphatic spread, R1-2 resection, and lack of chemotherapy.
  
  
  CONCLUSIONS
  Palliative resection is associated with a particularly unfavorable outcome in rectal cancer patients presenting with a locally advanced tumor (pT4, expected R2 resection) or an extensive comorbidity, and in all CRC patients who show a hepatic tumor load >50%. For such patients, surgery might be contraindicated unless the tumor is immediately life-threatening.
authors.affiliation: Department of Surgery, Klinikum Grosshadern, University of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany. axelkleespies@aol.com
authors.forename: Axel
authors.initials: A
authors.lastname: Kleespies
authors.forename: Kathrin E
authors.initials: KE
authors.lastname: Füessl
authors.forename: Hendrik
authors.initials: H
authors.lastname: Seeliger
authors.forename: Martin E
authors.initials: ME
authors.lastname: Eichhorn
authors.forename: Mario H
authors.initials: MH
authors.lastname: Müller
authors.forename: Markus
authors.initials: M
authors.lastname: Rentsch
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Thasler
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
authors.forename: Martin E
authors.initials: ME
authors.lastname: Kreis
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010166:Palliative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome