Surgical management for symptomatic primary tumors in unresectable stage IV rectal cancers.

AIM: This study aimed to describe the clinical characteristics, surgical selection patterns, and postoperative outcomes of patients who underwent either primary tumor resection (PTR) or ostomy for symptomatic unresectable stage IV rectal cancer in a real-world clinical setting. METHODS: We retrospectively reviewed 63 patients who underwent palliative surgery at Aichi Cancer Center Hospital between 2005 and 2023: PTR (n = 39) or ostomy (n = 24). The outcomes included postoperative complications, time to chemotherapy, and overall survival. RESULTS: Liver metastases were observed in 89.7% of the PTR group and 50.0% of the ostomy groups (p < 0.001), whereas distant lymph node metastases were more frequent in the ostomy group (p = 0.007). Postoperative complications were observed in 15.4% of the PTR group and 8.3% of the ostomy groups. The median interval to chemotherapy was 41 days in the PTR group and 15 days in the ostomy group (p < 0.001). Four patients (16.7%) in the ostomy group experienced tumor-related issues during chemotherapy. The five-year overall survival was 10.3% in the PTR group and 4.1% in the ostomy group (p = 0.390). CONCLUSIONS: PTR may delay chemotherapy owing to postoperative complications. These findings suggest the need for careful consideration of the risks and benefits when selecting surgical options for symptom control in patients with unresectable stage IV rectal cancer.