Long-term outcomes after surgical resection in patients with stage IV colorectal cancer: a retrospective study of 129 patients at a single institution

BACKGROUND AND PURPOSE: Approximately 20% of all patients with colorectal cancer (CRC) are diagnosed at more advanced stages with synchronous distant metastasis, and the prognosis in these patients is usually poor. The aim of this study was to determine the factors that can identify subgroup(s) of patients with stage IV CRC who could benefit from curative (R0) resection of both primary and metastatic lesions. PATIENTS AND METHODS: A total of 126 patients with stage IV CRC who underwent surgical resection of primary tumor were retrospectively analyzed. Among these patients, 26 cases of R0 resection were further examined subsequently. Information on various clinicopathological factors of the patients were obtained from hospital records. Overall survival was estimated using the Kaplan-Meier method, and log-rank tests were used to compare survival distribution. All the factors with P < 0.05 in univariate analysis were analyzed in the Cox proportional hazards model. RESULTS: CEA negativity, left-sided tumor, R0 resection, differentiated histology, and nodal staging less than N1 were independent factors that predicted better prognosis in all the 126 patients with stage IV CRC. Tumor depth of T3 or less was significantly correlated with better survival in patients who had undergone R0 resection. CONCLUSION: Our findings demonstrate that it is possible to select patients in whom surgical resection would yield better prognosis, from a variety of patient subgroups with stage IV CRC.