Prognostic factors after palliative resection for colorectal cancer with incurable synchronous liver metastasis

Purpose: With the improvements in newer chemotherapeutic agents, there is currently no consensus regarding the validity of palliative resection of the primary tumor for colorectal cancer with incurable distant metastasis. We retrospectively analyzed prognostic factor in patients with colorectal cancer accompanied by incurable synchronous liver metastasis. Methods: 82 patients with incurable synchronous liver metastases, who underwent primary tumor resection alone, were enrolled. Results: The multivariate analysis revealed that the presence of ascites (P = 0.001, Hazard ratio = 2.96) and differentiation (P = 0.003, Hazard ratio = 3.68) were found to be significant independent prognostic factors. The median survival time among the patients with ascites was 4.8 months and that among the patients with poorly-differentiated or mucinous adenocarcinoma, or signet ring cell carcinoma (high grade differentiation) was 1.4 months, respectively. Conclusion: The presence of ascites and differentiation were prognostic factors in the patients with incurable liver metastases. Therefore, because prognosis is generally poor after primary tumor resection in the patients with ascites or high grade differentiation, the introduction of systemic chemotherapy with alleviation of symptoms related to the primary tumor should be taken into account as one of the therapeutic strategies.

The validity of predicting prognosis by the number of lymph node metastases in node-positive colon cancer

Background: We examined the possibility of predicting prognosis by the number of lymph node metastases. Methods: Two hundred and forty nine patients with lymph node metastases who underwent curative surgery for colon cancer were enrolled in this study. We calculated cancer-specific survival according to the number of lymph node metastases. Results: There was a tendency toward better rates of cancer-specific survivals among the patients with 1 LNM, compared with those with 2 LNM (p = 0.07). When comparing cancer-specific survival between the patients with 1, 2-3 and 4 or more lymph node metastases, cancer-specific survival was well stratified (p i.e., the patients with 1, 2 and 3 and 4 or more lymph node metastases. This study was in favor of the TNM classification in which N category is classified by the number of lymph node metastases.

Neutrophil-Lymphocyte Ratio as a Prognostic Factor in Incurable Stage IV Colorectal Cancer

Objectives: Our aim is investigating the predictive potential of these available and convenient laboratory dates in stage IV colorectal cancer (CRC) patients. Methods: We identified the cases of 114 consecutive patients who underwent the surgery at our Hospital between January 2006 and December 2012 by using the multivariate analysis, the Cox proportional-hazard regression model. Results: Multivariate analysis for the predictors of survival showed metastatic lesion resection [hazard ratio (HR) = 3.2, 95% confidence interval (CI) 1.6 - 6.6;p = 0.007] and only primary lesion resection (HR = 1.9, 95% CI 1.1 - 4.0;p = 0.045) remained independently significant prognostic factors. Therefore, we divided in 3 groups, 1) metastatic lesion resection group with primary lesion resection (n = 52 in the Met/Prim lesion group), 2) primary lesion resection without metastatic lesion resection (n = 38 in the Primary lesion group) and 3) palliative operation (n = 24 in the Palliative group). Age was the only independent risk factor in the Met/Prim lesion group. In the Primary lesion group, Neutrophil lymphocyte ratio (NLR) > 5, elevated Alanine aminotransferase and patients without chemotherapy were correlated with poor survival. In the Palliative group, NLR > 5 and patients who could not be treated with chemotherapy remained independent predictors of worse survival. Conclusions: NLR is not only simple and convenient for classification of patients, but also one of the important predictors of mortality for stage IV incurable CRC patients.

Impact of Chylous Ascites on Colon Cancer in Laparoscopic Surgery

Objectives: To investigate the epidemiology and risk factors of chylous ascites. Methods: We identified the cases of 913 consecutive patients who underwenturgery for colorectal cancerat our University Hospital between January 2005and December2016. We divided the patients into thosewith and those without chylous ascites and compared the two groups by age, gender, body mass index, tumor location, T, N factor, stage, operation time, intra-operative bleeding, and duration of postoperative hospital stay. Results: Chylous ascites developed in 8 of the 913 patients (0.8%). Neither age, sex, tumor location, and body mass indexnor number of lymph nodeswereassociated with postoperative chylous ascites. Ascites occurred significantly less frequently in the early stage of colorectal cancer than in the late stage (p = 0.04). There was no significant difference between the groups in operative factors, including operation time and blood loss. Postoperative hospital stays were longer in patients with chylous ascites (20.5 days) than in those without (11 days) (p = 0.02). Conclusions: Late stage was one of the risk factors for chylous ascites in the present study. Other risks, such as tumor location and blood loss,will vary from institution to institution.