Tebala Giovanni Domenico, Di Cintio Antonio, Ricci Francesco, Avenia Stefano, Cirocchi Roberto, Desiderio Jacopo, Di Nardo Domenico, Di Saverio Salomone, Gemini Alessandro, Ranucci Maria Chiara, Trastulli Stefano, Cianchi Fabio, Scatizzi Marco, Catena Fausto
Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy.
Department of General Surgery, "Madonna del Soccorso" Hospital, 63074 San Benedetto del Tronto, Italy.
J Clin Med. 2023 May 16;12(10):3499. doi: 10.3390/jcm12103499.
The treatment of the primary tumour in colorectal cancer with unresectable liver and/or lung metastases but no peritoneal carcinomatosis is still a matter of debate. In the absence of clear evidence and guidelines, our survey was aimed at obtaining a snapshot of the current attitudes and the rationales for the choice of offering resection of the primary tumour (RPT) despite the presence of untreatable metastases.
An online survey was administered to medical professionals worldwide. The survey had three sections: (1) demographics of the respondent, (2) case scenarios and (3) general questions. For each respondent, an "elective resection score" and an "emergency resection score" were calculated as a percentage of the times he or she would offer RPT in the elective and in the emergency case scenarios. They were correlated to independent variables such as age, type of affiliation and specific workload.
Most respondents would offer palliative chemotherapy as the first choice in elective scenarios, while a more aggressive approach with RPT would be reserved for younger patients with good performance status and in emergency situations. Respondents younger than 50 years old and those with a specific workload of fewer than 40 cases of colorectal cancer per year tend to be more conservative.
In the absence of clear guidelines and evidence, there is a lack of consensus on the treatment of the primary tumour in case of colon cancer with unresectable liver and/or lung metastases and no peritoneal carcinomatosis. Palliative chemotherapy seems to be the first option, but more consistent evidence is needed to guide this choice.
对于伴有不可切除的肝和/或肺转移但无腹膜种植转移的结直肠癌原发肿瘤的治疗仍存在争议。在缺乏明确证据和指南的情况下，我们的调查旨在了解当前对于尽管存在无法治疗的转移灶仍选择切除原发肿瘤（RPT）的态度及理由。
对全球医学专业人员进行了一项在线调查。该调查有三个部分：（1）受访者的人口统计学信息，（2）病例场景，（3）一般问题。对于每位受访者，计算“择期切除评分”和“急诊切除评分”，以其在择期和急诊病例场景中选择RPT的次数占比表示。将这些评分与年龄、所属类型和特定工作量等独立变量相关联。
大多数受访者会在择期情况下将姑息化疗作为首选，而对于身体状况良好的年轻患者以及急诊情况，则会采取更积极的RPT方法。年龄小于50岁且每年结直肠癌特定工作量少于40例的受访者往往更为保守。
在缺乏明确指南和证据的情况下，对于伴有不可切除的肝和/或肺转移且无腹膜种植转移的结肠癌患者，其原发肿瘤的治疗缺乏共识。姑息化疗似乎是首选，但需要更多一致的证据来指导这一选择。
