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Treatment strategies for patients with stage IV rectal cancer: a report from the Swedish Rectal Cancer Registry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
2012 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, no 11, 1616-1623 p.Article in journal (Refereed) Published
Abstract [en]

Background: The optimal treatment strategy for patients with stage IV rectal cancer is unclear. The aim of the present study was to describe trends and compare the different treatment strategies for this group of patients at a national level and over time.

Methods: Data from 2758 rectal cancer patients with (stage IV group) and 13 420 without metastases (stage I-III group) were available from the Swedish Rectal Cancer Registry between January 1995 and December 2006.

Results: Patients with stage IV disease increased from 15 to 19 per cent between 1995 and 2006 (p<0.001) and the frequency of patients not operated increased from 13 to 26 per cent (p<0.001). Postoperative 30 day mortality after bowel resection was 2 per cent and after exploratory laparotomy 9 per cent. Median survival for stage IV patients operated with bowel resection was 16.3 months, an exploratory laparotomy 6.1 months, and for patients having no surgery 4.6 months. Patients aged 60-69 years increased their survival over time, irrespective of the treatment given. In the multivariate analysis, an increased risk of death was associated with: age > 80 years, operation at a local hospital, treatment in earlier time periods, not receiving preoperative radio- or chemotherapy, and not having a bowel resection.

Conclusion: Survival for stage IV rectal cancer patients improved in the latest time period despite the great increase in non-operated patients. Patients aged > 80 years should be carefully assessed and staged before surgery. The survival advantage for stage IV rectal cancer patients who underwent primary tumour resection is probably due to selection bias.

Place, publisher, year, edition, pages
2012. Vol. 48, no 11, 1616-1623 p.
Keyword [en]
Rectal cancer; Stage IV; Surgery; Palliative; Oncology; Survival
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-147879DOI: 10.1016/j.ejca.2011.12.012ISI: 000305781300004OAI: oai:DiVA.org:uu-147879DiVA: diva2:401086
Available from: 2011-03-01 Created: 2011-03-01 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Rectal Cancer: Surgical Strategies and Histopathological Aspects
Open this publication in new window or tab >>Rectal Cancer: Surgical Strategies and Histopathological Aspects
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The management of rectal cancer has changed in many countries over the last two decades and resulted in improved survival for the majority of rectal cancer patients. In this thesis some surgical strategies and histopathological aspects to improve and clarify the management of rectal cancer patients are investigated.

Even in the era of TME surgery and radiotherapy, a higher local recurrence rate and shorter survival for rectal cancer patients operated with abdominoperineal resection is reported. In the first paper we describe a new strategy with partial anterior en bloc resection of either the prostate or the vagina, resulting in very low local recurrence rates and excellent long-term survival. Histopathological examination of the specimen lays the foundation for decision making on oncological therapy. A positive circumferential resection margin (CRM) has, in previous papers, been related to a high risk of local recurrence. In the second paper we show that a CRM ≤ 1 mm was not correlated with an increased risk of local recurrence when patients were managed in a multidisciplinary setting with preoperative radiotherapy and optimal TME surgery. As the complexity of rectal cancer management is increasing, demands on organizational structure are growing. In paper three we could show that long-term survival was increased for all rectal cancer patients after the centralization to a single unit. Whether or not to resect the primary rectal tumour in patients with metastatic disease is an ongoing debate in the literature. In paper four, we studied the national management of rectal cancer patients with primary metastatic disease. Nineteen per cent of rectal cancer patients present with Stage IV disease and, at a national level, there is a clear shift to a more selective and restrictive approach. The 30-day mortality was low for patients that underwent a resectional surgery, for patients having an exploratory laparotomy, however, it was high. Overall survival was improved over time even though up to one fourth of patients received no surgical treatment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Uppsaliensis, 2011. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 652
Keyword
Rectal cancer, APR, en bloc resection, CRM, centralization, stage IV, metastases, palliative surgery, local recurrence, survival
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-147869 (URN)978-91-554-8020-2 (ISBN)
Public defence
2011-04-16, Aulan, ingång 21, Centrallasarettet, Västerås, 13:15 (English)
Opponent
Supervisors
Available from: 2011-03-24 Created: 2011-03-01 Last updated: 2011-05-04Bibliographically approved

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Hosseinali Khani, MaziarPåhlman, LarsSmedh, Kennet

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