Treatment strategies for patients with stage IV rectal cancer: a report from the Swedish Rectal Cancer Registry |
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| Authors: | Hosseinali Khani M Påhlman L Smedh K |
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| Institution: | 1. Colorectal Unit, Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanlands Hospital, SE-721 89 Västerås, Sweden;2. Department of Surgical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden;1. Institut de Cancérologie de l''Ouest (ICO) René Gauducheau, Saint-Herblain, France;2. Centre Catherine de Sienne, Nantes, France;3. Centre Jean Bernard, Le Mans, France;1. Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, Australia;2. Department of Medical Oncology, The Queen Elizabeth Hospital Woodville, Australia;3. The University of Adelaide, Adelaide, Australia;4. Department of Surgery, Flinders Medical Centre, Bedford Park, Australia;5. Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Australia;6. Sansom Institute for Health Research, University of South Australia, Australia;1. Centre Hépato-Biliaire, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Univ Paris-Sud, Villejuif, France;2. UMR-S776 Inserm, Villejuif, France;3. Departement of Pathology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France;4. University Medical Center Utrecht, Utrecht, The Netherlands;5. UMR-S785 Inserm, Villejuif, France;1. Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC;2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC;3. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC;4. PDStat LLC, Chapel Hill, NC;1. Profesor Titular de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España;2. Coordinador de la Unidad de Cirugía de la Pared Abdominal, Hospital Universitario Vall d’Hebron, Barcelona, España;3. Coordinador de la Sección de Pared Abdominal de la Asociación Española de Cirujanos (AEC), España |
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| Abstract: | BackgroundThe 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.MethodsData from 2758 rectal cancer patients with (stage IV) and 13,420 without metastases (stage I–III) were available from the Swedish Rectal Cancer Registry between January 1995 and December 2006.ResultsPatients with stage IV disease increased from 15% to 19% between 1995 and 2006 (p < 0.001) and the frequency of patients not operated on increased from 13% to 26% (p < 0.001). Postoperative 30 day mortality after bowel resection was 2% and after exploratory laparotomy 9%. Median survival for stage IV patients after bowel resection was 16.3 months, exploratory laparotomy 6.1 months and for patients having no surgery 4.6 months. Over time survival was improved for patients aged 60–69 years, irrespective of the treatment given. 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.ConclusionsIn the latest time period survival was improved for rectal cancer patients in stage IV 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 to more favourable cases. |
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