Analysis of surgical complications of primary tumor resection after neoadjuvant treatment in stage IV colon cancer.
OBJECTIVE
Assess the surgical complications of primary tumor resection in stage IV colon cancer patients previously treated with neoadjuvant chemotherapy.


METHODS
Between July 2001 and September 2010, 67 consecutive patients received preoperative chemotherapy. Clinical and surgical complications were obtained from the medical records. This study was retrospective in design.


RESULTS
All patients were affected with liver metastasis, and 29.8% had metastasis in additional organs. Three different schemes of preoperative chemotherapy were employed, based on FOLFIRI, XELOXIRI or XELOX plus cetuximab. Eighteen patients (26.8%) reported some side effects to the chemotherapy, without contraindicating any intervention. All patients underwent colon surgery and within those, eight patients (11.9%), underwent liver surgery simultaneously. Median hospital admission was 8 [3-29] days. The perioperative complication rate was 16.2%, when the estimated physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) was 58.3%. There was not perioperative mortality, despite the mortality prediction for Portsmouth-POSSUM (P-POSSUM) being 5.07%. No differences were observed between the chemotherapy regimen (P=0.72) or the kind of the surgery-simple or combined (P=0.58).


CONCLUSIONS
Neoadjuvant chemotherapy as a systemic treatment for stage IV colon cancer does not indicate surgery contraindication nor increases postoperative morbimortality by a significant amount.
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Jorge
J
Arredondo
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Patricia
P
Martínez
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Jorge
J
Baixauli
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Carlos
C
Pastor
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Javier
J
Rodríguez
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Fernando
F
Pardo
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Fernando
F
Rotellar
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
Ana
A
Chopitea
1 General Surgery Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain ; 2 General Surgery Department, Hospital Universitario Fundación Jiménez-Díaz, 28040 Madrid, Spain ; 3 Clinical Oncology Department, Clínica Universidad de Navarra, 31008 Pamplona, Navarra, Spain.
José Luís
JL
Hernández-Lizoáin
Stage IV colon cancer; neoajuvant chemotherapy; physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM); surgical morbidity