Cáceres Marta, Pascual Marta, Alonso Sandra, Montagut Clara, Gallén Manel, Courtier Ricard, Gil M José, Grande Luis, Andreu Montserrat, Pera Miguel
Unidad de Cirugía Colorrectal, Unidad Funcional de Cáncer Colorrectal, Hospital del Mar, Barcelona, España.
Unidad de Cirugía Colorrectal, Unidad Funcional de Cáncer Colorrectal, Hospital del Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
Cir Esp. 2014 Jan;92(1):30-7. doi: 10.1016/j.ciresp.2013.04.015. Epub 2013 Oct 28.
Although the conventional treatment of patients with stage iv colorectal cancer involves resection of the primary tumor followed by chemotherapy, several studies suggest that in patients with few symptoms the first and only treatment should be chemotherapy. The objective of this study is to analyze the complications related to the primary tumor in a series of patients with unresectable metastatic colorectal cancer treated with chemotherapy without surgery.
Retrospective descriptive study. The study included all patients with unresectable metastatic colorectal cancer treated with chemotherapy without resection of the primary tumor (January 2007-February 2011).
The mean age of the 61 patients analyzed was 67±13 years and the performance status was 0-1 in 53 (87%). Twenty (33%) patients developed complications during follow-up. The most common complication was intestinal obstruction in 15 (25%) patients followed by perforation. Complications required surgery in 6 (10%) cases. We did not find differences in patient characteristics between those who had a complication and those without, although the complication rate in patients with a colonic stent (53%) was twice that of other patients (26%).
Chemotherapy without surgery is a good option in most patients with unresectable metastatic colorectal cancer. However, although the percentage of patients requiring surgery is low, the total number of complications related to the primary tumor is not negligible. Studies are needed to identify those patients in whom a prophylactic colectomy could be indicated.
尽管IV期结直肠癌患者的传统治疗方法是先切除原发肿瘤，然后进行化疗，但多项研究表明，对于症状较轻的患者，首选且唯一的治疗方法应为化疗。本研究的目的是分析一系列接受化疗而非手术治疗的不可切除转移性结直肠癌患者中与原发肿瘤相关的并发症。
回顾性描述性研究。该研究纳入了所有在2007年1月至2011年2月期间接受化疗且未切除原发肿瘤的不可切除转移性结直肠癌患者。
分析的61例患者的平均年龄为67±13岁，53例（87%）患者的体能状态为0-1。20例（33%）患者在随访期间出现并发症。最常见的并发症是15例（25%）患者发生肠梗阻，其次是穿孔。6例（10%）患者的并发症需要手术治疗。我们未发现发生并发症的患者与未发生并发症的患者在特征上存在差异，尽管置入结肠支架的患者并发症发生率（53%）是其他患者（26%）的两倍。
对于大多数不可切除转移性结直肠癌患者，不进行手术而采用化疗是一种不错的选择。然而，尽管需要手术的患者比例较低，但与原发肿瘤相关的并发症总数不容小觑。需要开展研究以确定哪些患者适合进行预防性结肠切除术。
