PDF(Pubmed)
Abstract：
BACKGROUND: The treatment of the primary tumour in colorectal cancer with unresectable liver and/or lung metastases but no peritoneal carcinomatosis is still a matter of debate. In the absence of clear evidence and guidelines, our survey was aimed at obtaining a snapshot of the current attitudes and the rationales for the choice of offering resection of the primary tumour (RPT) despite the presence of untreatable metastases.
METHODS: An online survey was administered to medical professionals worldwide. The survey had three sections: (1) demographics of the respondent, (2) case scenarios and (3) general questions. For each respondent, an \"elective resection score\" and an \"emergency resection score\" were calculated as a percentage of the times he or she would offer RPT in the elective and in the emergency case scenarios. They were correlated to independent variables such as age, type of affiliation and specific workload.
RESULTS: Most respondents would offer palliative chemotherapy as the first choice in elective scenarios, while a more aggressive approach with RPT would be reserved for younger patients with good performance status and in emergency situations. Respondents younger than 50 years old and those with a specific workload of fewer than 40 cases of colorectal cancer per year tend to be more conservative.
CONCLUSIONS: In the absence of clear guidelines and evidence, there is a lack of consensus on the treatment of the primary tumour in case of colon cancer with unresectable liver and/or lung metastases and no peritoneal carcinomatosis. Palliative chemotherapy seems to be the first option, but more consistent evidence is needed to guide this choice.
METHODS: An online survey was administered to medical professionals worldwide. The survey had three sections: (1) demographics of the respondent, (2) case scenarios and (3) general questions. For each respondent, an \"elective resection score\" and an \"emergency resection score\" were calculated as a percentage of the times he or she would offer RPT in the elective and in the emergency case scenarios. They were correlated to independent variables such as age, type of affiliation and specific workload.
RESULTS: Most respondents would offer palliative chemotherapy as the first choice in elective scenarios, while a more aggressive approach with RPT would be reserved for younger patients with good performance status and in emergency situations. Respondents younger than 50 years old and those with a specific workload of fewer than 40 cases of colorectal cancer per year tend to be more conservative.
CONCLUSIONS: In the absence of clear guidelines and evidence, there is a lack of consensus on the treatment of the primary tumour in case of colon cancer with unresectable liver and/or lung metastases and no peritoneal carcinomatosis. Palliative chemotherapy seems to be the first option, but more consistent evidence is needed to guide this choice.
摘要：
背景：对于不可切除的肝和/或肺转移但无腹膜癌的结直肠癌原发肿瘤的治疗仍存在争议。在缺乏明确证据和指导方针的情况下，我们的调查旨在获得尽管存在无法治疗的转移,但选择切除原发肿瘤(RPT)的当前态度和理由的快照.
方法：对全球医疗专业人员进行了一项在线调查。调查分为三个部分：(1)受访者的人口统计，（2）案例场景和（3）一般问题。对于每个受访者来说，“择期切除评分”和“急诊切除评分”计算为他或她在择期和急诊病例中提供RPT的次数的百分比.它们与独立变量相关，如年龄，隶属关系类型和具体工作量。
结果：大多数受访者将姑息化疗作为首选方案，而更积极的RPT方法将保留给表现良好的年轻患者和紧急情况。年龄小于50岁的受访者以及每年少于40例结直肠癌患者的特定工作量的受访者往往更为保守。
结论：在缺乏明确的指南和证据的情况下，对于不可切除的肝和/或肺转移且无腹膜癌的结肠癌，对原发性肿瘤的治疗缺乏共识。姑息化疗似乎是第一选择,但需要更一致的证据来指导这一选择。
方法：对全球医疗专业人员进行了一项在线调查。调查分为三个部分：(1)受访者的人口统计，（2）案例场景和（3）一般问题。对于每个受访者来说，“择期切除评分”和“急诊切除评分”计算为他或她在择期和急诊病例中提供RPT的次数的百分比.它们与独立变量相关，如年龄，隶属关系类型和具体工作量。
结果：大多数受访者将姑息化疗作为首选方案，而更积极的RPT方法将保留给表现良好的年轻患者和紧急情况。年龄小于50岁的受访者以及每年少于40例结直肠癌患者的特定工作量的受访者往往更为保守。
结论：在缺乏明确的指南和证据的情况下，对于不可切除的肝和/或肺转移且无腹膜癌的结肠癌，对原发性肿瘤的治疗缺乏共识。姑息化疗似乎是第一选择,但需要更一致的证据来指导这一选择。
