Predictive factors of surgery in metastatic colorectal cancer: a retrospective cohort study

Abstract

Introduction

Current management of metastatic colorectal cancer is based on neoadjuvant chemotherapy. Few studies have reported on surgery procedures in patients with metastatic colorectal cancer. The objective of this study was to describe our institutional experience with emergency surgery performed in patients with metastatic colorectal cancer during chemotherapy.

Patients and methods

This was a retrospective cohort study including adult patients of ≤80 years with a metastatic colorectal cancer between 2017 and 2020 and undergoing surgery during chemotherapy. Statistical analyses were based on Kaplan–Meier’s curve and Cox proportional hazard model. The surgery statistical risk during chemotherapy was studied through all tumor and patient’s characteristics. Multivariable logistic regression models were used to identify predictive factors of emergency surgery in these patients.

Results

Seventy-two cases were identified and 60% patients undergone an emergency surgery. By Kaplan–Meier’s analyses, intestinal surgery was much more frequent and early in patients who have severe stenosis (either blocking or only permeable using a gastroscope) at the time of diagnosis. Patients with severe malignant stenosis presented a 6.28 time higher surgery risk (p < .0001). The median time between admission and surgery was 54 days in patients with severe stenosis who were operated.

Conclusion

The degree of colorectal tumor stenosis measured by endoscopy was a risk factor for emergency surgery in patients with metastatic colorectal cancer during neoadjuvant chemotherapy. In this group of patients presenting low survival outcomes, further studies are needed to define the place of preventive surgery, avoiding emergency surgery and morbidity in such fragile patients.

Keywords:

• Metastatic colorectal cancer
• surgery
• colorectal tumor stenosis
• colorectal cancer

Author contributions

Raffaele Calicis: conceptualization, methodology, investigation, writing, review and editing. Antoine Dubois: conceptualization, writing, review and editing. Christian Ritter: software, formal analysis, data curation and visualization. Nicolas Tinton: resources, investigation and visualization. Benjamin Calicis: resources, investigation and visualization. Yves Hoebeke: resources, investigation and visualization. David Lepore: resources, investigation and visualization. Francisco Da Rocha De Sousa: resources, investigation and visualization. Emmanuel Cambier: resources, investigation and visualization. Fabrice Corbisier: conceptualization, methodology, review and editing, visualization and supervision.

Ethical approval

This study was approved by the Grand Hôpital de Charleroi Institutional Research Ethics Board. As the study is based on a retrospective anonymous database analyses, patient inform consent was waived by the ethical board due to the nature of the study.

Disclosure statement

The authors have no conflicts of interest to disclose.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, R.F.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.