RESUMEN
BACKGROUND: The optimal treatment strategy for patients with stage IV rectal cancer is unclear. The aim of the present study was to describe trends and compare the different treatment strategies for this group of patients at a national level and over time. METHODS: Data from 2758 rectal cancer patients with (stage IV) and 13,420 without metastases (stage I-III) were available from the Swedish Rectal Cancer Registry between January 1995 and December 2006. RESULTS: Patients with stage IV disease increased from 15% to 19% between 1995 and 2006 (p<0.001) and the frequency of patients not operated on increased from 13% to 26% (p<0.001). Postoperative 30 day mortality after bowel resection was 2% and after exploratory laparotomy 9%. Median survival for stage IV patients after bowel resection was 16.3 months, exploratory laparotomy 6.1 months and for patients having no surgery 4.6 months. Over time survival was improved for patients aged 60-69 years, irrespective of the treatment given. An increased risk of death was associated with: age >80 years, operation at a local hospital, treatment in earlier time periods, not receiving preoperative radio- or chemotherapy and not having a bowel resection. CONCLUSIONS: In the latest time period survival was improved for rectal cancer patients in stage IV despite the great increase in non-operated patients. Patients aged >80 years should be carefully assessed and staged before surgery. The survival advantage for stage IV rectal cancer patients who underwent primary tumour resection is probably due to selection to more favourable cases.