Abstract
Objectives: For patients with unresectable synchronous liver metastasis, the treatment is complex and the advantages of palliative resection of the primary colon tumor have not been finally determined. Surgeons sometimes experience difficulty deciding to implement palliative primary colon cancer resection. The choice should depend on surgical risk, severity of symptoms and life expectancy. This study was designed to identify factors reducing survival post palliative surgery among patients with unresectable liver metastasis. Methods: A retrospective review of 212 colon cancer patients with unresectable liver metastases who received palliative surgery from 1995 to 2000 was conducted in this study. Clinical-pathological data were collected from medical records. Significance testing was performed using the Kaplan-Meier method to analyze survival difference and the Cox proportional hazard model for independent prognostic factor. Results: Altogether 183 patients received palliative resection of primary colon cancer and 29 patients received non-resection (bypass or diversion) surgery. Factors evaluated for survival were age, gender, comorbid heart disease, hemoglobin, albumin, bilirubin, tumor size, tumor cell differentiation, tumor resection, extent of liver metastasis, extent of systemic metastasis and chemotherapy. There were 15 postoperative deaths. The mean survival was 12.6 months for the palliative resection group and 4.7 months for the non-resection group. Patients with poor tumor differentiation, advanced liver metastases, multiple systemic metastases and absence of chemotherapy had significantly worse rates of survival. Conclusions: Palliative surgery for asymptomatic or minor symptomatic patients with poor tumor differentiation, advanced liver metastases or multiple systemic metastases is of limited survival benefit, unless the tumors are complicated with obstruction, perforation or bleeding. Postoperative chemotherapy is advocated after any type of palliative resection.
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