title: Complications from the primary tumour are not related with survival in patients with synchronous stage IV colorectal cancer receiving chemotherapy without primary tumour resection.
abstract: BACKGROUND
  The aim of this study was to evaluate the rate of complications from the primary tumour (CPT) requiring surgical or endoscopic intervention during chemotherapy treatment in patients with incurable synchronous stage IV colorectal cancer, the possibility of predicting such complications and their influence on survival.
  
  
  METHODS
  One hundred and twenty-five patients were initially treated with chemotherapy. Patients were grouped on the basis of appearance or not of CPT. We assessed the relation between age, gender, carcinoembryonic antigen (CEA) level, primary tumour location, alkaline phosphatase level, unilobar or bilobar liver involvement, presence of peritoneal carcinomatosis, the number of sites of metastatic disease, the addition of target therapies to chemotherapy, the ability to traverse the tumour with an endoscope and the appearance of complications due to the primary tumour and overall survival.
  
  
  RESULTS
  Mean age was 64.9 years, and 89 patients were men. Over a mean of 234 days, 25 patients (20 %) developed a CPT. Eighteen patients required surgery, and seven were treated exclusively by an endoscopic procedure. Mean survival was 15.8 months. We found a statistically relevant correlation between the inability to traverse the tumour with an endoscope and the occurrence of a CPT. There was no statistical differences in survival between both groups, but patients receiving target therapies had better survival.
  
  
  CONCLUSIONS
  Twenty percent of patients will suffer a CPT during chemotherapy treatment. The inability to pass the tumour with an endoscope can predict the CPT. Survival was only related to the addition of target therapies to chemotherapy.
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, c/ Irunlarrea 3, 31008, Pamplona, Spain. fj.suarez.alecha@cfnavarra.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Suárez
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, c/ Irunlarrea 3, 31008, Pamplona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Marín
authors.affiliation: Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Vera
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, c/ Irunlarrea 3, 31008, Pamplona, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Oronoz
authors.affiliation: Department of General Surgery, Coloproctology Unit, Complejo Hospitalario de Navarra, c/ Irunlarrea 3, 31008, Pamplona, Spain.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Oteiza
authors.affiliation: Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Mata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002272:Carcinoembryonic Antigen / Q000097:blood; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D007416:Intestinal Perforation / Q000209:etiology; D008113:Liver Neoplasms / Q000201:enzymology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D002272:Carcinoembryonic Antigen; D000469:Alkaline Phosphatase
keywords: Colorectal cancer; Metastatic colorectal cancer; Self-expanding metallic stent; Synchronous metastatic colorectal cancer; Upfront chemotherapy