@article{0598ce6e6a6d4f0eab26963499a73d46,
title = "Nonoperative management of the primary tumor in patients with unresectable stage IV colon cancer treated with systemic chemotherapy: Higher complication rates for left-sided colon tumors",
abstract = "Introduction: Treatment of the primary tumor in asymptomatic patients with unresectable colorectal metastases remains controversial. Methods: Data from patients with synchronous stage IV colon cancer and an untreated primary tumor who started treatment aimed at metastatic disease at a specialized cancer center between 2014 and 2018 were analyzed retrospectively. Main outcome was primary tumor-related complications comparing left-sided and right-sided colon cancer. A competing-risk regression model was used to identify predictors of complications. Results: Of 523 patients with metastatic colon cancer at presentation, 221 started treatment aimed at metastatic disease; these patients constituted the study cohort. The primary tumor was left-sided in 109 patients (49%) and right-sided in 112 patients (51%). In total, 46 patients (21%) developed a complication that required invasive intervention. Complications occurred more frequently in patients with left-sided tumors than in patients with right-sided tumors (29% vs 13%, P = 0.003). Eighteen patients (8%) underwent non-surgical intervention. Six patients (33%) failed non-surgical management and underwent surgery. Of 34 patients (15%) who underwent surgical intervention, 20 underwent an emergency colectomy and 14 underwent diversion with a permanent stoma. Overall, 10% of patients ended up with a permanent stoma. In competing-risk analysis, only left-sided primary tumor (hazard ratio 2.62; 95% CI 1.40–4.89; P = 0.003) was significantly associated with primary tumor-related complications requiring invasive intervention. Conclusions: Patients with asymptomatic metastatic left-sided tumors have a higher risk for primary tumor-related complications than patients with right-sided tumors. Close monitoring and early surgical rescue should be considered for patients with left-sided colon cancer who are managed nonoperatively.",
keywords = "Complications, Non-surgical intervention, Primary tumor, Stage IV colon cancer, Surgical intervention",
author = "Verheij, {Floris S.} and Yuval, {Jonathan B.} and Kok, {Niels F.M.} and Lin, {Sabrina T.} and Qin, {Li Xuan} and Omer, {Dana M.} and Thompson, {Hannah M.} and Wei, {Iris H.} and Maria Widmar and Pappou, {Emmanouil P.} and Weiser, {Martin R.} and Nash, {Garrett M.} and Smith, {J. Joshua} and Paty, {Philip B.} and Beets, {Geerard L.} and Julio Garcia-Aguilar",
note = "Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology",
year = "2024",
month = jan,
doi = "10.1016/j.ejso.2023.107294",
language = "אנגלית",
volume = "50",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "1",
}