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Abstract Background In patients with stage IV colorectal cancer (CRC), minimally invasive surgery (MIS) may offer optimal oncologic outcome with low morbidity. However, the relative benefit of MIS compared to open surgery in patients requiring multistage resections has not been evaluated. Methods Patients who underwent totally minimally invasive (TMI) or totally open (TO) resections of CRC primary and liver metastases (CLM) in 2009–2016 were analyzed. Inverse probability of weighted adjustment by propensity score was performed before analyzing risk factors for complications and survival. Results The study included 43 TMI and 121 TO patients. Before and after adjustment, TMI patients had significantly less cumulated postoperative complications (41% vs. 59%, p = 0.001), blood loss (median 100 vs. 200 ml, p = 0.001) and shorter length of hospital stay (median 4.5 vs. 6.0 days, p < 0.001). Multivariate analysis identified TO approach vs. MIS (OR = 2.4, p < 0.001), major liver resection (OR = 4.4, p < 0.001), and multiple CLM (OR = 2.3, p = 0.001) as independent risk factors for complications. 5-year overall survival was comparable (81% vs 68%, p = 0.59). Conclusion In patients with CRC undergoing multistage surgical treatment, MIS resection contributes to optimal perioperative outcomes without compromise in oncologic outcomes. Synopsis: A coordinated preplanned approach to total laparoscopic multistage resection of stage IV colorectal cancer optimizes short-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Emergency treatment of perforated colon cancer has traditionally been linked with dismal outcomes due to the double jeopardy of a septic insult combined with a malignant disease, leaving unclear how aggressive emergency surgical procedures should be. We aimed to define short- and long-term outcomes in the current era of critical care support and oncologic advances, to provide updated data for decision making.Study Design: Patients with perforations associated with a primary colon cancer were identified. Peri-operative and long-term survival were compared among free (FP; n = 41) and contained perforations (CP; n = 45) and to age-, stage-, and resection status case-matched, non-perforated (NP; n = 85), controls.Results: Tumors were completely resected in 67% of FP but fewer lymph nodes were harvested (median, 11 vs. 11 and 16 in CP and NP; p = 0.21 and p < 0.001). Peri-operative mortality was highest in FP: 19% vs. 0% and 5% in CP and NP (p = 0.038), respectively. After adjusting for peri-operative mortality, 5-year overall survival was comparable: 55%, 59%, and 54% for FP, CP, and NP, respectively. Advanced age, higher ASA class, presence of residual disease, and advanced stage, but not perforation, were independent predictors of poorer long-term overall survival.Conclusions: Patients with malignant colonic perforation face high risk of peri-operative death, making septic source control the priority in the acute setting. Pursuit of an oncologically oriented resection and long-term cancer-directed treatments, however, may lead to improved long-term outcomes. [ABSTRACT FROM AUTHOR]

Advances in molecular biology have enabled identification of tumor biomarkers that allow for individualized risk assessment for patients with cancer. Molecular predictors of clinical outcome can help inform discussion regarding the role of adjuvant chemotherapy in patients with resected colon cancer, such as those with stage II colon cancer in which the benefit of adjuvant therapy is controversial or those with stage III colon cancer who may have a lower risk of recurrence and less absolute benefit from oxaliplatin therapy. This article summarizes the data surrounding the development, validation, and clinical and economic utility of the Oncotype DX® colon cancer assay, a multigene expression assay validated to independently predict recurrence risk in patients with stage II and III colon cancer beyond traditional factors. [ABSTRACT FROM AUTHOR]

Background: With advances in multimodality therapy, colorectal cancer survivors are living longer. However, little is known about the quality of their long-term survival. We investigated the functional outcomes and symptoms among long-term survivors. Methods: A cross-sectional study of 1,215 long-term (>5 years) colorectal cancer survivors was conducted using a validated disease-specific questionnaire. Younger onset survivors (18-50 years) were matched 1:2 to later onset survivors (>50 years). Standardized mean scores were compared using one-way ANOVA. Key patient and treatment factors that impact function and symptoms were assessed by multivariate linear regression. Results: Eight hundred thirty survivors responded at an interval of 10.8 ± 3 years from diagnosis (68 % response rate). Younger onset survivors underwent more surgery (97.9 vs. 93.6 %, P < 0.001) and received more chemotherapy (86.1 vs. 77.7 %, P = 0.004). Anxiety, body image, sexual dysfunction, embarrassment by bowel movements, micturition problems, and impotence were significant concerns. Younger onset survivors reported worse anxiety, body image, and embarrassment with bowel movements, whereas later onset survivors highlighted sexual dysfunction, micturition problems, and impotence. Age at diagnosis was a key independent determinant of long-term function and symptoms. Conclusion: Long-term survivors of CRC face ongoing functional deficits and symptoms, and their survivorship experience differs by age. Age at diagnosis should serve as a basis for tailored, personalized survivorship care plans. [ABSTRACT FROM AUTHOR]

Background: Traditionally, for patients with colorectal cancer with resectable synchronous liver metastases, resections were performed separately. However, the safety and efficacy of simultaneous resection have been demonstrated in selected patients. The purpose of this study was to evaluate outcomes and economic implications of simultaneous and staged resections. Study Design: We conducted a retrospective cohort study of consecutive colorectal cancer patients with resectable synchronous liver metastases treated between 1993 and 2010, constructing a decision tree comparing simultaneous and staged resections. For generalizability, the analysis was conducted from a payer perspective, using costs derived from 2010 Medicare reimbursement. Decision models incorporated the severity-refined DRG complications (complicating condition/major complicating condition) modifiers. Sensitivity analyses used alternative models of DRG reimbursement. Results: There were 144 patients analyzed. Sixty (41.7%) underwent simultaneous resection and 84 (58.3%) underwent staged resection. Median overall survival did not differ between the simultaneous and the staged cohorts (66.3 vs 65.6 months, respectively), nor did the overall complication rate (38.3% vs 40.5%, respectively). Median total length of hospitalization was significantly shorter in the simultaneous cohort (8 vs 14 days; p = 0.001). In the base model, the simultaneous strategy cost less than the staged strategy ($20,983 vs $25,298 per case)—a savings of 17.1%. Sensitivity analyses examining alternative severity-refined DRG reimbursements demonstrated potential cost savings, in all but 1 extreme sensitivity analysis, ranging from 9.8% to 27.3% favoring simultaneous resection. Conclusions: The simultaneous resection strategy was oncologically equivalent and more cost efficient for patients with primary colorectal cancer presenting with resectable liver metastases. A reduction in overall length of hospital stay was an associated benefit. Future studies should explore the feasibility and clinical implications of policies to maximize the potential for simultaneous resection in this cohort of patients. [Copyright &y& Elsevier]