Nonsurgical treatment of the primary tumor in four consecutive cases of metastasized colorectal carcinoma.

BACKGROUND AND STUDY AIMS: Surgical resection of the primary tumor is standard treatment in stage IV colorectal cancer, but palliative surgery is associated with high morbidity and mortality and with uncertain benefit. The wisdom of surgical resection of asymptomatic or oligosymptomatic primary tumors is therefore questionable. By studying a small series of such patients, we aimed to assess whether endoscopic techniques can offer an effective alternative form of nonsurgical palliative treatment for the prevention of local complications caused by a primary colorectal tumor. PATIENTS AND METHODS: We treated four consecutive patients who had stage IV colorectal cancer by endoscopic tumor debulking, either using a standard polypectomy snare technique alone or by argon plasma coagulation ablation followed by snare debulking of the primary tumor.
RESULTS: Palliation was achieved in all patients, demonstrated by regression of the primary tumor and absence of symptoms related to the colonic tumor during the observation period of up to 24 months. No procedure-associated complications were observed and it was possible to commence systemic chemotherapy immediately after the endoscopic treatment in all four patients.
CONCLUSIONS: We believe that surgical resection of the primary tumor is not appropriate in all patients with stage IV colorectal cancer, and that this form of treatment should be reserved for patients with signs of complete obstruction in whom local ablative procedures are not possible. Simple endoscopic techniques for treatment of the primary tumor, in conjunction with systemic chemotherapy, may be the most suitable form of management for patients with stage IV colorectal tumors.