The prognostic impact of primary tumor resection or stoma construction followed by systemic chemotherapy for stage IV colorectal cancer: A Japanese, multicenter study.

[PURPOSE] Few reports have so far compared cases of Stage IV colorectal cancer in which primary tumor resection or stoma creation was performed prior to systemic chemotherapy.

[METHODS] We retrospectively reviewed 246 patients with clinical Stage IV colorectal cancer who underwent surgery followed by systemic chemotherapy. The patients were divided into two groups: those who underwent only stoma creation (stoma group, n = 62) and those who underwent primary tumor resection (resection group, n = 164).

[RESULTS] The stoma group had more male patients (stoma group vs. resection group, 74.2% vs. 54.8%; p = 0.009), more comorbidities (88.7% vs. 73.2%, p = 0.012), and more rectal tumors (38.7% vs. 11.0%; p < 0.001); after propensity score matching, no differences were seen, but shorter operation time (110 vs. 174 min; p < 0.001), less blood loss (5 vs. 11 mL; p < 0.001), longer hospital stay (19 vs. 14 days; p = 0.003), and a shorter duration from surgery to first chemotherapy (27 vs. 35 days; p < 0.001) were seen in the stoma group, with a better overall survival in the resection group (p = 0.036).

[CONCLUSION] Primary resection of stage IV colorectal cancer is associated with a better prognosis. However, highly invasive surgery may cause postoperative complications and a poor prognosis; therefore, careful consideration of its appropriateness is necessary.