Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer

Int J Colorectal Dis. 2009 Sep;24(9):1097-109. doi: 10.1007/s00384-009-0734-y. Epub 2009 Jun 3.


Purpose: 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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colonic Neoplasms / complications
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / surgery*
  • Comorbidity
  • Elective Surgical Procedures / adverse effects*
  • Elective Surgical Procedures / mortality
  • Female
  • Humans
  • Liver Neoplasms
  • Male
  • Middle Aged
  • Morbidity
  • Palliative Care*
  • Prognosis
  • Rectal Neoplasms / complications
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / surgery*
  • Risk Assessment
  • Survival Rate
  • Treatment Outcome