Is there a Role for Primary Surgical Resection in the Palliative Rectal Cancer Setting: A Systematic Re-view
Main Article Content
Abstract
Introduction: There are over 42,000 new cases of colorectal cancer diagnosed every year in the UK alone, a third of those being rectal in origin. Although there has been significant progress in the treatment of rectal cancer, overall, 5-year survival can still be as low as 17% for those with advanced disease. We aimed to assess the impact on of overall survival and quality of life of primary tumour resection in the palliative setting.
Method: A literature search was performed using Pubmed and Cochrane databases in March 2022. Bias was assessed using the Joanna Briggs institute checklist.
Results: Seven papers were included in the review; all retrospective cohort. A total of 809 patients underwent rectal resection in the presence of metastatic disease +/- adjuvant therapy. The median age was 61years, 59.7% male. 68.6% of patients presented with liver metastasis at the time of diagnosis. The most commonly reported symptoms preoperatively were bleeding and tenesmus. 4-50% of patients in each cohort underwent neoadjuvant therapy. Highest 30-day mortality reported was 7.3%. Both studies comparing resection v none demonstrated a higher overall survival for those undergoing surgery, with one showing 1year overall
survival 65v20%. Quality of life was not addressed across the literature.
Conclusion: Although there is some evidence to show a favourable overall survival for patients undergoing primary tumour resection in the palliative setting, this data is mainly old and across a heterogeneous population. A larger scale prospective study would be required to assess its potential role and impact upon quality of life.
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References
2. Heald, R.J. and Ryall, R.D.H. (1986) ‘Recur-rence and survival after total mesorectal exci-sion for rectal cancer’, The Lancet, 327(8496), pp. 1479–1482. doi:10.1016/s0140-6736(86)91510-2.
3. Colorectal cancer - risk factors and prevention (2022) Cancer.Net. Available at: https://www.cancer.net/cancer-types/colorectal-cancer/risk-factors-and-prevention (Accessed: 29 May 2023).
4. Zhao, X.-F. et al. (2021) ‘TMPRSS4 overex-pression promotes the metastasis of colorectal cancer and predicts poor prognosis of stage III–IV colorectal cancer’, The International Journal of Biological Markers, 36(3), pp. 23–32. doi:10.1177/17246008211046368.
5. Ronnekleiv-Kelly, S.M. (2011) ‘Management of stage IV rectal cancer: Palliative Options’, World Journal of Gastroenterology, 17(7), p. 835. doi:10.3748/wjg.v17.i7.835.
6. Abdalla, E.K. et al. (2004) ‘Recurrence and outcomes following hepatic resection, radiof-requency ablation, and combined resec-tion/ablation for colorectal liver metastases’, Annals of Surgery, 239(6), pp. 818–827. doi:10.1097/01.sla.0000128305.90650.71.
7. Palliative care (no date) World Health Organi-zation. Available at: https://www.who.int/news-room/fact-sheets/detail/palliative-care (Accessed: 29 May 2023).
8. Yeh, C.-H. et al. (2011) ‘Comparison of treat-ment results between surgery alone, preopera-tive short-course radiotherapy, or long-course concurrent chemoradiotherapy in locally ad-vanced rectal cancer’, International Journal of Clinical Oncology, 17(5), pp. 482–490. doi:10.1007/s10147-011-0317-0.
9. Morris, E.J. et al. (2021) ‘Impact of the COVID-19 pandemic on the detection and manage-ment of colorectal cancer in England: A popu-lation-based study’, The Lancet Gastroenterol-ogy & Hepatology, 6(3), pp. 199–208. doi:10.1016/s2468-1253(21)00005-4.
10. Lewis, P.J. et al. (2021) ‘Covid RT – assessing the impact of COVID-19 on radiotherapy in the UK. A National Cancer Research Institute Clinical and Translational Radiotherapy Re-search Working Group Initiative in partnership with the Royal College of Radiologists, the so-ciety of radiographers and the Institute of Physics and Engineering in Medicine’, Clinical Oncology, 33(1). doi:10.1016/j.clon.2020.08.008.
11. Clifford, R.E. et al. (2021) ‘Rectal cancer man-agement during the COVID-19 pandemic (re-cap): Multicentre prospective observational study’, British Journal of Surgery, 108(11), pp. 1270–1273. doi:10.1093/bjs/znab129.
12. Chambers, A.C. et al. (2020) ‘Demographic trends in the incidence of young-onset colorec-tal cancer: A population-based study’, British Journal of Surgery, 107(5), pp. 595–605. doi:10.1002/bjs.11486.
13. Al-Sanea, N. and Isbister, W.H. (2004) ‘Is pal-liative resection of the primary tumour, in the presence of advanced rectal cancer, a safe and useful technique for symptom control?’, ANZ Journal of Surgery, 74(4), pp. 229–232. doi:10.1111/j.1445-2197.2004.02946.x.
14. Heah, S.M. et al. (1997) ‘Hartmann’s proce-dure vs. abdominoperineal resection for palli-ation of advanced low rectal cancer’, Diseases of the Colon & Rectum, 40(11), pp. 1313–1317. doi:10.1007/bf02050815.
15. Longo, W.E. et al. (1988) ‘Advanced rectal cancer’, Diseases of the Colon & Rectum, 31(11), pp. 842–847. doi:10.1007/bf02554846.
16. Verberne CJ, de H, M.E.J. Pijl, Baas P, Siesling S, Wiggers T. Palliative resection of the pri-mary tumour in stage IV rectal cancer. 2012;14(3):314-319. doi: https://doi.org/10.1111/j.1463-1318.2011.02618.x
17. Nash GM, Saltz LB, Kemeny NE, et al. Radical resection of rectal cancer primary tumor pro-vides effective local therapy in patients with stage IV disease. 2002;9(10):954-960. doi: https://doi.org/10.1007/bf02574512
18. Kleespies A, Füessl KE, Seeliger H, et al. De-terminants of morbidity and survival after elective non-curative resection of stage IV co-lon and rectal cancer. International Journal of Colorectal Disease. 2009;24(9):1097-1109. doi: https://doi.org/10.1007/s00384-009-0734-y
19. Sigurdsson HK, H. Kørner, Dahl O, A. Skarstein, Søreide JA. Palliative surgery for rectal can-cer in a national cohort. 2008;10(4):336-343. doi:https://doi.org/10.1111/j.1463-1318.2007.01376.x
20. TNM staging (2022) Bowel Cancer | Cancer Research UK. Available at: https://www.cancerresearchuk.org/about-cancer/bowel-cancer/stages-types-and-grades/TNM-staging (Accessed: 29 May 2023).
21. Fowler, H. et al. (2020) ‘Hartmann’s procedure versus intersphincteric abdominoperineal exci-sion (hip study): A multicentre prospective co-hort study’, Colorectal Disease, 22(12), pp. 2114–2122. doi:10.1111/codi.15366.
22. Jayne, D. et al. (2017) ‘Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rec-tal cancer’, JAMA, 318(16), p. 1569. doi:10.1001/jama.2017.7219.
23. Robinson, C.N. et al. (2010) ‘Minimally inva-sive surgery improves short term outcomes in elderly colorectal cancer patients’, Journal of Surgical Research, 158(2), p. 271. doi:10.1016/j.jss.2009.11.281.
24. Gustafsson, U.O. et al. (2018) ‘Guidelines for perioperative care in elective colorectal sur-gery: Enhanced recovery after surgery (ERAS®) society recommendations: 2018’, World Journal of Surgery, 43(3), pp. 659–695. doi:10.1007/s00268-018-4844-y.