Nonoperative management of primary colorectal cancer in patients with stage IV disease.

摘要: Background: Traditional teaching maintains that patients with primary colorectal adenocarcinoma require timely resection to prevent bleeding, perforation, or obstruction. The true benefits of tumor remain undocumented for presenting metastatic disease, however. We postulated tumors could be avoided safely in a select population asymptomatic cancer incurable stage IV disease. Methods: A retrospective review the Vanderbilt University Hospital registry was performed years 1985 1997. During this period, 955 presented management cancer. From group, all disease at time diagnosis were identified. Patients who initially underwent their lesion included group; those initial nonoperative nonresection group. Data obtained regarding age, extent nonsurgical therapy, tumor-specific complications, and palliative surgical procedures. Surgery-free survival overall analyzed using Kaplan-Meier method. For liver metastases, hepatic burden defined as either H1 ( 50%) Results: Sixty-six 23 intact lesions Among most both groups had Ten group 3 exclusively extrahepatic metastases. In therapy chemotherapy 13 patients, external beam radiation 1 patient, combination chemoradiation 9 patients. median 16.6 months. 2-year actuarial 18%, surgery-free 91.3%. Only 2 (8.7%) managed without eventually developed obstruction site requiring emergent diversion. There no episodes tumor-related hemorrhage perforation. operative morbidity 30.3%, perioperative mortality rate 4.6%. 14.5 months (P = 0.59, log-rank test vs. group). Conclusions: Selected present may avoid lesions, an anticipated low hemorrhage, before death from systemic No advantage is gained by setting