Factors associated with survival in incurable asymptomatic stage IV colorectal cancer patients who underwent palliative primary tumor resection and chemotherapy

Aim: Our study aims to provide a summary of the short-term and survival outcomes of patients with stage IV colorectal cancer who have unresectable metastasis and have undergone primary tumor resection with chemotherapy and identify the factors that predict survival outcome. Method: A multicentre, retrospective, observational study was conducted, and all stage IV minimally symptomatic colorectal patients undergoing primary tumor resection with chemotherapy between January 2017 and March 2022 were included. The significant factors predicting survival outcome were evaluated by using multivariate logistic regression analysis model. Results: One hundred thirty-three patients (57% male) with a mean age of 56 ± 12 years. The most common tumors were left-sided colon cancers (62%). Seventy-nine patients (59%) had LN metastasis. The lung was the most common metastatic site (71%). Major postoperative morbidity rate was 38% (50 of 133) and the treatment related mortality rate was 2%(3 of 133). The mean survival time was 25 ± 16 months. The median number of in-hospital days during the course of treatment was 9 (3–68) days. The results of multivariate logistic regression analysis revealed three factors that were significantly associated with poor survival: positive pathological lymph node (OR 4.24, CI 0.74– 7.73, p= 0.018), Anastomotic leak (OR 11.61, CI 11.6–21.6, p= 0.023) and other complications (burst abdomen, enterocutaneous fistula, acute coronary syndrome, hospitalacquired infection) (OR 22.67, CI 7.94–37.4, p= 0.003). Conclusion: In patients with incurable Stage IV colorectal cancer whose primary tumor is minimally symptomatic, a treatment strategy that includes resection of the primary tumor is associated with treatment-related morbidity and mortality, longer hospital stays, and postoperative morbidity that reduces survival.