Surgery of the Primary Tumour in Stage IV Colorectal Cancer with Unresectable Metastases
Table 2: Studies Comparing Resection versus Non-resection of the Primary Tumour in Stage IV Colorectal Cancer and Unresectable Metastases
Author Mäkelä34 Scoggins40 Liu14 Tebbutt50 Konyalian58 Beham59 Costi19 Yun60 Stelzner61 Galizia62 Law16 Ruo51 Michel45 Mik63 Benoist44 Kaufman64 Aslam65 Bajwa66 Evans67 Chan68 Frago69 Seo70 Venderbosch54 Years of Study 1974–1983 1985–1997 1986–1991 1990–1999 1991–2002 1993–2003 1994–2003 1994–2004 1995–2001 1995–2005 1996–1999 1996–1999 1996–1999 1996–2000 1997–2002 1998–2003 1998–2007 1999–2005 1999–2006 2000–2002 2000–2008 2001–2008 2003–2004 2005–2006 Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection Resection
Non-resection
Number of Patients 66 30 66 23 57 6
280 82 62 47 46 21 83 47
283 93
128 58 42 23
150 30
127 103 31 23 52 82 32 27
115 69
366 281 32 35 45 57
286 125 12 43
144 83
258 141 289 159
Overall Survival (months) 15 7
14.5 16.6 11 3
14
8.2 13 5
18 8 9 4
15.3 5.3
11.4 4.6
15.2 12.3 7 3
16 9
21 14 21 14 23 22 22 3
14.5 5.83 14 6
11 7
14 6
39.1 1.0 22 14 17 11 21 13
p-value -- 0.59 -- 0.08 <0.0001 <0.001 <0.001 <0.001 <0.0001 0.03 <0.001 <0.001 0.718 NS -- <0.0001 <0.005 0.005 0.2056 <0.001 0.008 0.076 0.0001 0.0001
Post-operative Mortality % 5
17 5
-- 9
17 -- -- 5 6 3 0 8
15 3
--
12 10 -- -- 7
21 2
-- 0
-- -- -- 0
-- -- -- 8
-- 3
--
16 36 -- -- 8 6 0
-- -- -- -- --
Resection was defined as resection of the primary tumour and non-resection was defined as surgical intervention without resection of the primary tumour. NS = not stated.
emergency surgery is required, was addressed in several studies, where the risk of death was found to be extremely low.39,43–45
In fact,
Poultsides and Paty compared their study population with studies with elective colon resection in the metastatic setting and found that it appears that this deferred approach is associated with at least comparable peri-operative mortality.46
Another argument for
chemotherapy first is that chemotherapy will not only treat the metastases but also the primary tumour; many patients will have improvements of their symptoms, therefore avoiding a possible
EUROPEAN ONCOLOGY & HAEMATOLOGY
Advocates of the deferred surgical approach argue that surgery at diagnosis can delay or even preclude systemic chemotherapy, and that most patients will never develop symptoms and these patients
29
Chau et al. demonstrated that, overall, 86 % of patients had an improvement in symptoms. Of the patients with symptoms, 71 % had diminished pelvic pain/tenesmus, 90 % had improvement in diarrhoea/constipation, 100 % had reduced rectal bleeding and 93 % had weight stabilisation or weight gain.
resection.37,47 -- -- -- -- -- -- 0.784 -- 0.01 -- -- -- -- -- -- -- p-value -- -- -- -- -- -- 0.397 --
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