Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 2;10(12):3114.
doi: 10.3390/biomedicines10123114.

Survival Outcomes after Elective or Emergency Surgery for Synchronous Stage IV Colorectal Cancer

Ji-Yeon Mun  1 , Ji-Eun Kim  1 , Nina Yoo  1 , Hyeon-Min Cho  1 , Hyunho Kim  2 , Ho-Jung An  2 , Bong-Hyeon Kye  1
Affiliations

Survival Outcomes after Elective or Emergency Surgery for Synchronous Stage IV Colorectal Cancer

Ji-Yeon Mun et al. Biomedicines. .

Abstract

Patients with stage IV colorectal cancer (CRC) who have not undergone primary tumor resection (PTR) are at risk of sudden medical emergencies. Despite the ongoing controversy over the necessity and timing of PTR in patients with stage IV CRC, studies comparing the survival outcomes of elective and emergency surgery in this population are scarce. This is a retrospective study conducted at a single institute. The patients were divided into two groups: the elective surgery (ELS) group (n = 46) and the emergency surgery (EMS) group (n = 26). The primary outcome was 2-year overall survival (OS). During a median follow-up period of 27.0 months, the 2-year OS was significantly better in the ELS group (80% vs. 42.9%, p = 0.002). No significant differences were observed in the 2-year relapse-free survival and 30-day postoperative complication rates. Planning and performing elective surgery could help increase the survival rate of patients with synchronous stage IV CRC, especially those that undergo simultaneous or staged metastasectomy.

Keywords: emergency; metastasectomy; primary tumor resection; stage IV colorectal cancer.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram CRC, colorectal cancer; PTR, primary tumor resection.
Figure 2
Figure 2
Comparison of 2-year survival outcomes between the elective surgery (ELS) and emergency surgery (EMS) groups: (a) 2-year overall survival; (b) 2-year relapse-free survival.
Figure 3
Figure 3
Comparison of 2-year survival outcomes between the elective surgery (ELS) and emergency surgery (EMS) groups according to initial resectability: (a) 2-year overall survival in initially resectable patients; (b) 2-year overall survival in initially unresectable patients.
Figure 4
Figure 4
Comparison of 2-year survival outcomes between surgery first patients in the elective group and patients with an emergent event during chemotherapy.
Figure 5
Figure 5
C Comparison of 2-year overall survival between patients who received postoperative adjuvant chemotherapy (post-op CTx) and those who did not. ELS/CTx(+), elective surgery + post-op CTx; ELS/CTx(−), elective surgery + no post-op CTx; EMS/CTx(+), emergency surgery + post-op CTx; EMS/CTx(−), emergency surgery + no post-op CTx.
Figure 6
Figure 6
Stoma-free survival of patients undergoing left-side colectomy in the elective surgery (ELS) and emergency surgery (EMS) groups.
See this image and copyright information in PMC

References

    1. Steinberg S.M., Barkin J.S., Kaplan R.S., Stablein D.M. Prognostic indicators of colon tumors. The Gastrointestinal Tumor Study Group experience. Cancer. 1986;57:1866–1870. doi: 10.1002/1097-0142(19860501)57:9<1866::AID-CNCR2820570928>3.0.CO;2-T. - DOI - PubMed
    1. Rosen S.A., Buell J.F., Yoshida A., Kazsuba S., Hurst R., Michelassi F., Millis J.M., Posner M.C. Initial Presentation with Stage IV Colorectal Cancer: How aggressive should we be? Arch. Surg. 2000;135:530–534. doi: 10.1001/archsurg.135.5.530. discussion 534–535. - DOI - PubMed
    1. Ali S.M., Pawlik T.M., Rodriguez-Bigas M.A., Monson J.R., Chang G.J., Larson D.W. Timing of Surgical Resection for Curative Colorectal Cancer with Liver Metastasis. Ann. Surg. Oncol. 2018;25:32–37. doi: 10.1245/s10434-016-5745-7. - DOI - PubMed
    1. Kopetz S., Chang G.J., Overman M.J., Eng C., Sargent D., Larson D.W., Grothey A., Vauthey J.-N., Nagorney D.M., McWilliams R.R. Improved Survival in Metastatic Colorectal Cancer Is Associated with Adoption of Hepatic Resection and Improved Chemotherapy. J. Clin. Oncol. 2009;27:3677–3683. doi: 10.1200/JCO.2008.20.5278. - DOI - PMC - PubMed
    1. Network N.C.C. Colon Cancer (Version 1.2022) [(accessed on 11 June 2022)]. Available online: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1428.

LinkOut - more resources