BACKGROUND AND AIMS: Patients with metastatic colorectal cancer have a limited life expectancy and are at risk for life-threatening tumor-related obstruction, perforation, and hemorrhage. Though surgical resection is performed frequently in this setting, its true benefit is not well-established. MATERIALS AND METHODS: We reviewed the medical literature from 1996-2006 using the search terms metastatic colorectal cancer and primary resection to find studies that evaluated the management of primary tumors in metastatic colorectal cancer. All search results were included in our analysis and were assessed on the basis of methodologic quality. RESULTS/ FINDINGS: Twelve relevant studies were identified; ten were single-institution retrospective reviews and two were population-based studies using National Cancer Institute's Surveillance, Epidemiology, and End-Results database. No prospective or randomized studies were identified. Approximately 70% of patients diagnosed with metastatic colorectal cancer in the USA undergo primary tumor resection; only a minority have this done for tumor-related symptoms or as part of potentially curative resection. The postoperative mortality ranged from 9.0-11.2% in large cancer registries but was often lower in major cancer centers. Resection of asymptomatic primary tumors was frequently associated with prolonged survival but was not found to reduce significantly the incidence of life-threatening tumor-related complications. INTERPRETATION/ CONCLUSION: Retrospective data suggest that non-curative resection of asymptomatic colorectal primary tumors may prolong survival; however, selection bias and unaccounted clinical factors may explain this observation. Prospective, randomized surgical trials are needed to test the role of primary tumor resection in this setting, especially because of its current widespread use, and its associated cost, morbidity, and high postoperative mortality.
BACKGROUND AND AIMS: Patients with metastatic colorectal cancer have a limited life expectancy and are at risk for life-threatening tumor-related obstruction, perforation, and hemorrhage. Though surgical resection is performed frequently in this setting, its true benefit is not well-established. MATERIALS AND METHODS: We reviewed the medical literature from 1996-2006 using the search terms metastatic colorectal cancer and primary resection to find studies that evaluated the management of primary tumors in metastatic colorectal cancer. All search results were included in our analysis and were assessed on the basis of methodologic quality. RESULTS/ FINDINGS: Twelve relevant studies were identified; ten were single-institution retrospective reviews and two were population-based studies using National Cancer Institute's Surveillance, Epidemiology, and End-Results database. No prospective or randomized studies were identified. Approximately 70% of patients diagnosed with metastatic colorectal cancer in the USA undergo primary tumor resection; only a minority have this done for tumor-related symptoms or as part of potentially curative resection. The postoperative mortality ranged from 9.0-11.2% in large cancer registries but was often lower in major cancer centers. Resection of asymptomatic primary tumors was frequently associated with prolonged survival but was not found to reduce significantly the incidence of life-threatening tumor-related complications. INTERPRETATION/ CONCLUSION: Retrospective data suggest that non-curative resection of asymptomatic colorectal primary tumors may prolong survival; however, selection bias and unaccounted clinical factors may explain this observation. Prospective, randomized surgical trials are needed to test the role of primary tumor resection in this setting, especially because of its current widespread use, and its associated cost, morbidity, and high postoperative mortality.
Authors: Garrett M Nash; Leonard B Saltz; Nancy E Kemeny; Bruce Minsky; Sunil Sharma; Gary K Schwartz; David H Ilson; Eileen O'Reilly; David P Kelsen; Daniel R Nathanson; Martin Weiser; Jose G Guillem; W Douglas Wong; Alfred M Cohen; Philip B Paty Journal: Ann Surg Oncol Date: 2002-12 Impact factor: 5.344
Authors: Graeme J Poston; René Adam; Steven Alberts; Steven Curley; Juan Figueras; Daniel Haller; Francis Kunstlinger; Gilles Mentha; Bernard Nordlinger; Yehuda Patt; John Primrose; Mark Roh; Philippe Rougier; Theo Ruers; Hans Joachim Schmoll; Carlos Valls; Nick Jean-Nicolas Vauthey; Marleen Cornelis; James P Kahan Journal: J Clin Oncol Date: 2005-10-01 Impact factor: 44.544
Authors: Herbert Hurwitz; Louis Fehrenbacher; William Novotny; Thomas Cartwright; John Hainsworth; William Heim; Jordan Berlin; Ari Baron; Susan Griffing; Eric Holmgren; Napoleone Ferrara; Gwen Fyfe; Beth Rogers; Robert Ross; Fairooz Kabbinavar Journal: N Engl J Med Date: 2004-06-03 Impact factor: 91.245
Authors: Christina Cellini; Steven R Hunt; James W Fleshman; Elisa H Birnbaum; Andrew J Bierhals; Matthew G Mutch Journal: World J Surg Date: 2010-05 Impact factor: 3.352
Authors: Louis de Mestier; Gilles Manceau; Cindy Neuzillet; Jean Baptiste Bachet; Jean Philippe Spano; Reza Kianmanesh; Jean Christophe Vaillant; Olivier Bouché; Laurent Hannoun; Mehdi Karoui Journal: World J Gastrointest Oncol Date: 2014-06-15