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İmamoğlu Gİ, Oğuz A, Cimen S, Eren T, Karacin C, Colak D, Altşbaş M, Türker S, Yazılıta D. The impact of lymph node ratio on overall survival in patients with colorectal cancer. J Cancer Res Ther 2021; 17:1069-1074. [PMID: 34528566 DOI: 10.4103/jcrt.jcrt_11_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution. Materials and Methods We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan-Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively. Results Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 [95% confidence interval: 2.15-8.34]; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value. Conclusions This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for "PLNR," prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.
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Affiliation(s)
- Goksen İnanğ İmamoğlu
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Arzu Oğuz
- Department of Medical Oncology, Baskent University, Ankara, Turkey
| | - Sanem Cimen
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Tülay Eren
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Cengiz Karacin
- Department of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Dilşen Colak
- Department of Medical Oncology, Baskent University, Ankara, Turkey
| | - Mustafa Altşbaş
- Department of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Sema Türker
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Doğan Yazılıta
- Department of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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Systematic review of the influence of socioeconomic deprivation on mortality after colorectal surgery. Br J Surg 2018; 105:959-970. [DOI: 10.1002/bjs.10848] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 01/12/2023]
Abstract
Abstract
Background
Socioeconomic deprivation is a potentially important factor influencing surgical outcomes. This systematic review aimed to summarize the evidence for any association between socioeconomic group and mortality after colorectal surgery, and to report the definitions of deprivation used and the approaches taken to adjust for co-morbidity in this patient population.
Methods
MEDLINE, Embase, the Cochrane Library and Web of Science were searched for studies up to November 2016 on adult patients undergoing major colorectal surgery, which reported on mortality according to socioeconomic group. Risk of bias and study quality were assessed by extracting data relating to study size, and variations in inclusion and exclusion criteria. Quality was assessed using a modification of a previously described assessment tool.
Results
The literature search identified 59 studies published between 1993 and 2016, reporting on 2 698 403 patients from eight countries. Overall findings showed evidence for higher mortality in more deprived socioeconomic groups, both in the perioperative period and in the longer term. Studies differed in how they defined socioeconomic groups, but the most common approach was to use one of a selection of multifactorial indices based on small geographical areas. There was no consistent approach to adjusting for co-morbidity but, where this was considered, the Charlson Co-morbidity Index was most frequently used.
Conclusion
This systematic review suggests that socioeconomic deprivation influences mortality after colorectal surgery.
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Shen P, Stewart JH, Levine EA. Metastases of colorectal cancer to the liver and peritoneum: comparison of surgical paradigms. Expert Rev Anticancer Ther 2014; 8:1797-808. [DOI: 10.1586/14737140.8.11.1797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Perry Shen
- Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - John H Stewart
- Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Edward A Levine
- Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Gorey KM, Luginaah IN, Holowaty EJ, Zou G, Hamm C, Bartfay E, Kanjeekal SM, Balagurusamy MK, Haji-Jama S, Wright FC. Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996-2011. BMC Public Health 2012; 12:897. [PMID: 23092403 PMCID: PMC3507906 DOI: 10.1186/1471-2458-12-897] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/16/2012] [Indexed: 01/02/2023] Open
Abstract
Background We examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California. Methods We analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor), middle poverty (5-29% poor) and low poverty (less than 5% poor). Primary health insurers were Medicaid, Medicare, private or none. Results Evidence of mediation was observed for women, but not for men. For women, the apparent effect of poverty disappeared in the presence of payer, and the effects of all forms of health insurance seemed strengthened. All were advantaged on 6-year survival compared to the uninsured: Medicaid (RR = 1.83), Medicare (RR = 1.92) and private (RR = 1.83). Evidence of moderation was also only observed for women. The effects of all forms of health insurance were stronger for women in low poverty neighborhoods: Medicaid (RR = 2.90), Medicare (RR = 2.91) and private (RR = 2.60). For men, only main effects of poverty and payers were observed, the advantaging effect of private insurance being largest. Across colon cancer care processes, Medicare seemed most instrumental for women, private payers for men. Conclusions Health insurance substantially mediates the quality of colon cancer care and poverty seems to make the effects of being uninsured or underinsured even worse, especially among women in the United States. These findings are consistent with the theory that more facilitative social and economic capital is available in more affluent neighborhoods, where women with colon cancer may be better able to absorb the indirect and direct, but uncovered, costs of care.
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Affiliation(s)
- Kevin M Gorey
- School of Social Work, University of Windsor, Windsor, Ontario, N9B 3P4, Canada.
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Hemminki K, Santi I, Weires M, Thomsen H, Sundquist J, Bermejo JL. Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes. BMC Cancer 2010; 10:688. [PMID: 21176147 PMCID: PMC3022888 DOI: 10.1186/1471-2407-10-688] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/21/2010] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Old age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. Recent data show that colonoscopy is efficient in preventing left-sided cancers only. We examine the association of Tumor Node Metastasis (TNM) classes with diagnostic age and patient characteristics. METHODS The Swedish Family-Cancer Database has data on TNM classes on 6,105 CRC adenocarcinoma patients. Ordinal logistic regression analysis was performed to model tumor characteristics according to age at diagnosis, tumor localization, gender, socioeconomic status, medical region and family history. The results were compared to results from survival analysis. RESULTS The only parameters systematically associated with TNM classes were age and tumor localization. Young age at diagnosis was a risk factor for aggressive CRC, according to stage, N and M with odds ratios (ORs) ranging from 1.80 to 1.93 for diagnosis before age 50 years compared to diagnosis at 80+ years. All tumor characteristics, particularly T, were worse for colon compared to rectal tumors. Right-sided tumors showed worse characteristics for all classifiers but M. The survival analysis on patients diagnosed since 2000 showed a hazard ratio of 0.55 for diagnosis before age 50 years compared to diagnosis at over 80 years and a modestly better prognosis for left-sided compared to right-sided tumors. CONCLUSIONS The results showed systematically more aggressive tumors in young compared to old patients. The poorer survival of old patients in colon cancer was not related to the available tumor characteristics. However, these partially agreed with the limited colonoscopic success with right-sided tumors.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Irene Santi
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Marianne Weires
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Hauke Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Justo Lorenzo Bermejo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Germany
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Effectiveness of a multimedia-based educational intervention for improving colon cancer literacy in screening colonoscopy patients. Dis Colon Rectum 2010; 53:1301-7. [PMID: 20706074 DOI: 10.1007/dcr.0b013e3181e291c0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Limited data exist regarding colon cancer literacy in screening colonoscopy patients. We aimed to prospectively assess baseline colon cancer literacy and to determine whether a multimedia educational intervention was associated with improved colon cancer literacy. METHODS Colon cancer literacy was assessed in a convenience sample of colonoscopy patients before and after educational intervention. Statistically significant associations with colon cancer literacy scores were assessed by use of multivariate logistic regression analysis. Results are frequency (proportion), mean +/- SD, and odds ratio (OR (95% CI)). RESULTS Seventy-three subjects participated: mean age, 57 +/- 12 years, 35 (48%) were women, 41 (57%) had a college degree, 43 (59%) had prior colonoscopy, 21 (29%) were accompanying family, and 16 (22%) were health care employees. Multivariate factors associated with a higher baseline colon cancer literacy score included health care employee status (7.9 (95% CI, 1.6-63); P = .02) and family colon cancer history (5.3 (95% CI, 1.3-25); P = .02). After multimedia education, mean scores improved from 53% +/- 23% to 88% +/- 12% (Delta = 35%; P < .0001). On univariate analysis, college-educated subjects had higher final scores (91% vs 83%; P = .007), but this association was not significant on multivariate regression (P = .07). Only baseline score was associated with higher postintervention score (1.7 (95% CI, 1.2-2.6); P = .005). Sixty-two subjects (86%) were very satisfied, and 70 (97%) would recommend the module to friends and family. CONCLUSION A knowledge deficit of colon cancer-related concepts is frequently observed in patients undergoing screening colonoscopy. Multimedia-based educational intervention was an effective, satisfying strategy for addressing cancer-specific knowledge deficit in laypersons.
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Gorey KM, Luginaah IN, Bartfay E, Fung KY, Holowaty EJ, Wright FC, Hamm C, Kanjeekal SM. Effects of socioeconomic status on colon cancer treatment accessibility and survival in Toronto, Ontario, and San Francisco, California, 1996-2006. Am J Public Health 2010; 101:112-9. [PMID: 20299655 DOI: 10.2105/ajph.2009.173112] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California. METHODS We analyzed registry data for colon cancer patients from Ontario (n = 930) and California (n = 1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses. RESULTS Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After adjustment for stage, survival was better for low-income residents of Toronto than for those of San Francisco. Middle- to low-income patients were more likely to receive indicated chemotherapy in Toronto than in San Francisco. CONCLUSIONS Socioeconomic factors appear to mediate colon cancer care in urban areas of the United States but not in Canada. Improvements are needed in screening, diagnostic investigations, and treatment access among low-income Americans.
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Affiliation(s)
- Kevin M Gorey
- School of Social Work, University of Windsor, Windsor, Ontario, Canada.
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Soler-Vilá H, Dubrow R, Franco VI, Saathoff AK, Kasl SV, Jones BA. Cancer-specific beliefs and survival in nonmetastatic colorectal cancer patients. Cancer 2009; 115:4270-82. [PMID: 19731356 DOI: 10.1002/cncr.24583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third leading cause of cancer mortality in the United States. Associations between cancer-specific beliefs (beliefs) and survival have been observed among other cancer populations, but similar research in CRC patients is virtually nonexistent, especially in racially diverse populations. The relationship between beliefs and survival was investigated in a cohort of African Americans and non-Hispanic whites with newly diagnosed nonmetastatic CRC, followed for up to 15 years. METHODS The authors analyzed data from a population-based cohort of 286 individuals (115 African Americans and 171 whites, approximately 52% women) diagnosed with nonmetastatic CRC in Connecticut, 1987 to 1991. Cox proportional hazards models were adjusted for sociodemographic (age, sex, race, education, income, occupational status, marital status) and biomedical (stage at diagnosis, histological grade, treatment) variables. RESULTS Not believing in the curability of cancer increased the risk of all-cause mortality (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.06-2.39) and CRC-specific mortality (HR, 1.65; 95% CI, 0.90-3.03; P=.10). These multivariate estimates were not altered by additional adjustment for insurance coverage, obesity, smoking, alcohol consumption, or comorbidity. Furthermore, the association between perceived curability and survival did not vary significantly by key sociodemographic or biomedical factors. Other beliefs were not associated with survival. CONCLUSIONS Among a racially diverse cohort of men and women with CRC, believing in the curability of cancer was independently associated with survival over a 15-year period. Confirmation of the role of cancer-specific beliefs on survival and study of the potential biobehavioral mechanisms is needed. Findings may inform the design of interventions for cancer survivors.
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Affiliation(s)
- Hosanna Soler-Vilá
- Department of Epidemiology and Public Health, Sylvester Comprehensive Cancer Center, Leonard Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.
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Holubar SD, Hassinger JP, Dozois EJ, Wolff BG, Kehoe M, Cima RR. Impact of a Multimedia e-Learning Module on Colon Cancer Literacy: A Community-Based Pilot Study. J Surg Res 2009; 156:305-11. [DOI: 10.1016/j.jss.2009.03.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 03/20/2009] [Accepted: 03/25/2009] [Indexed: 11/30/2022]
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Tehranifar P, Neugut AI, Phelan JC, Link BG, Liao Y, Desai M, Terry MB. Medical advances and racial/ethnic disparities in cancer survival. Cancer Epidemiol Biomarkers Prev 2009; 18:2701-8. [PMID: 19789367 PMCID: PMC3665008 DOI: 10.1158/1055-9965.epi-09-0305] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although advances in early detection and treatment of cancer improve overall population survival, these advances may not benefit all population groups equally and may heighten racial/ethnic differences in survival. METHODS We identified cancer cases in the Surveillance, Epidemiology and End Results program, who were ages > or = 20 years and diagnosed with one invasive cancer in 1995 to 1999 (n = 580,225). We used 5-year relative survival rates to measure the degree to which mortality from each cancer is amenable to medical interventions (amenability index). We used Kaplan-Meier methods and Cox proportional hazards regression to estimate survival differences between each racial/ethnic minority group relative to Whites, by the overall amenability index, and three levels of amenability (nonamenable, partly amenable, and mostly amenable cancers, corresponding to cancers with 5-year relative survival rate < 40%, 40-69%, and > or = 70%, respectively), adjusting for gender, age, disease stage, and county-level poverty concentration. RESULTS As amenability increased, racial/ethnic differences in cancer survival increased for African Americans, American Indians/Native Alaskans, and Hispanics relative to Whites. For example, the hazard ratios (95% confidence intervals) for African Americans versus Whites from nonamenable, partly amenable, and mostly amenable cancers were 1.05 (1.03-1.07), 1.38 (1.34-1.41), and 1.41 (1.37-1.46), respectively. Asians/Pacific Islanders had similar or longer survival relative to Whites across amenability levels; however, several subgroups experienced increasingly poorer survival with increasing amenability. CONCLUSIONS Cancer survival disparities for most racial/ethnic minority populations widen as cancers become more amenable to medical interventions. Efforts in developing cancer control measures must be coupled with specific strategies for reducing the expected disparities.
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Affiliation(s)
- Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th, New York, NY 10032, USA.
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Reese JA, Hall C, Bowles K, Moesinger RC. Colorectal surgical specimen lymph node harvest: improvement of lymph node yield with a pathology assistant. J Gastrointest Surg 2009; 13:1459-63. [PMID: 19459019 DOI: 10.1007/s11605-009-0820-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/28/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Adequate lymph node harvest from colorectal cancer specimens has become a standard of care, influencing both staging and survival. To improve lymph node harvests at our hospital, a pathology assistant was trained to meticulously harvest lymph nodes from colorectal cancer specimens. An analysis of trends in lymph node harvests over time is presented. METHODS The number of harvested lymph nodes from 391 consecutive colorectal cancer pathology reports was retrospectively reviewed from a single community hospital over 8 years (1999-2006). This spanned 4 years prior to the training of the pathology assistant and 4 years after. RESULTS From 1999-2002, the mean number of harvested lymph nodes varied from 12.2 to 14.4. The percentage of specimens achieving 12 lymph nodes was 50-67%. From 2003-2006, the mean number of harvested lymph nodes increased to 18.4-20.7, while the percentage of specimens achieving 12 lymph nodes was 83-87%. Both of these improvements achieved statistical significance with p values of <0.00001. CONCLUSIONS Over time, lymph node harvests at our hospital dramatically improved. The training of a pathology assistant to harvest the lymph nodes from colorectal cancer specimens dramatically affected lymph node harvests and can be a crucial component of pathologic analysis of these specimens.
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Affiliation(s)
- Jeffery A Reese
- Department of Radiology, McKay-Dee Hospital Center, 4403 Harrison Boulevard, Ogden, UT 84403, USA
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Shen P, Thai K, Stewart JH, Howerton R, Loggie BW, Russell GB, Levine EA. Peritoneal surface disease from colorectal cancer: comparison with the hepatic metastases surgical paradigm in optimally resected patients. Ann Surg Oncol 2008; 15:3422-32. [PMID: 18784963 DOI: 10.1245/s10434-008-0127-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/31/2008] [Accepted: 08/01/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical resection is the treatment of choice for colorectal hepatic metastases (HM). In contrast, metastatic disease to the peritoneum is treated with systemic therapy. We examined our experience with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal surface disease (PSD) compared with liver resection for HM. METHODS A review of prospective databases of colorectal cancer patients undergoing surgery for metastatic disease to the peritoneum or liver (1992-2005) was carried out. RESULTS One hundred and twenty-one patients underwent CS + IPHC and 101 patients underwent hepatic resection with median follow-up of 86 and 56 months, respectively. Fifty-five (45%) patients in the IPHC group had complete resection of all gross tumor. Ninety-five (94%) of the HM patients had negative surgical margins. Comparison of the R0/R1 PSD and margin-negative HM group demonstrated significant differences in age, performance status, and preoperative chemotherapy. The 1-, 3-, and 5-year overall survival for the R0/R1 PSD patients was 91, 48, and 26%; while it was 87, 59, and 34% for the HM patients (P = 0.32). Perioperative morbidity was 42% versus 34% (P = 0.38) and mortality was 5.5% versus 4.2% (P = 0.71) between the PSD and HM patients, respectively. CONCLUSION R0/R1 resection during CS + IPHC compared with margin-negative hepatic resection demonstrated no significant difference in overall survival and for select patients should be considered a viable treatment option. Further studies to improve the resectability of PSD patients and define the role of neoadjuvant and adjuvant drug strategies are needed.
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Affiliation(s)
- Perry Shen
- Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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