Clinical Significance of Palliative Resection in Advanced Colorectal Cancer

Lee, Han Il; Yu, Chang Sik; Kim, Chang Nam; Kim, Jin Cheon

Abstract

Palliative resection in colorectal cancer seems to be questioned due to high mortality and morbidity in spite of relief of cancer symptom and lengthening of survival time. We studied to identify benefits of palliative resection in advanced colorectal cancer. We retrospectively reviewed 96 patients who underwent palliative surgery during June 1989 to December 1995 at Asan Medical Center and evaluated quality of life(QOL), rates of morbidity and mortality, chemotherapy response rates, duration of symptom free and survival time. The overall rate of palliative surgery in total colorectal cancer patients was 9.1%(96/1055) and the most common location of primary tumor was rectum. The causes of palliative surgery were hepatic metastases(44), peritoneal disseminations(20), local invasions(17), combined causes(14) and lung metastases(one) in descending order. Postoperative complication was 13.3% (6/45) after resection surgery and 25.5%(13/51)after non-resection surgery. Mortality rates was 0 and 9.8 percent, respectively. Improvement of QOL was 75.6% and 72.5%, respectively. However, 30 cases(65.2%) showed still moderate or severe degree of poor QOL in non-resection group compared with 11.1% of resection group postoperatively. Response rates of postoperative adjuvant chemotherapy was higher(31.8% vs. 7.4%) and median relief of preoperative cancer symptom was longer(6.2 vs. 3.0 months) in resection group. One year survival rates were 42% in resection surgery and 16.7% in non-resection surgery Palliative resection can improve QOL, response rates of postoperative adjuvant chemotherapy, relief of preoperative cancer symptom and survival rates without increase of morbidity or mortality. So if feasible, palliative resection should be encouraged in selected patients.