PURPOSE: Resection of the primary tumor in patients with unresected metastatic colorectal cancer is controversial, and often performed only for palliation of symptoms. Our goal was to determine if resection of the primary tumor in this patient population is associated with improved survival. METHODS: This is a retrospective cohort study of the National Cancer Data Base from 2004 to 2012. The study population included all patients with synchronous metastatic colorectal adenocarcinoma who were treated with systemic chemotherapy. The study groups were patients who underwent definitive surgery for the primary tumor and those who did not. Patients were excluded if they had surgical intervention on the sites of metastasis or pathology other than adenocarcinoma. Primary outcome was overall survival. RESULTS: Of the 65,543 patients with unresected stage IV colorectal adenocarcinoma undergoing chemotherapy, 55% underwent surgical resection of the primary site. Patients who underwent surgical resection of the primary tumor had improved median survival compared to patients treated with chemotherapy alone (22 vs 13 months, p < .0001). The surgical survival benefit was present for patients who were treated with either multi-agent or single-agent chemotherapy (23 vs 14 months, p < 0.001; 19 vs 9 months, p < 0.001). Surgical resection of the primary tumor was also associated with improved survival when using multivariate analysis with propensity score matching (OR = 0.863; 95% CI [0.805-.924]; HR = 0.914; 95% CI [0.888-0.942]). CONCLUSIONS: Our results show that in patients with synchronous unresected stage IV colorectal adenocarcinoma undergoing single- or multi-agent chemotherapy, after adjusting for confounding variables, definitive resection of the primary site was associated with improved overall survival. Large randomized controlled trials are needed to determine if there is a causal relationship between surgery and increased overall survival in this patient population.
PURPOSE: Resection of the primary tumor in patients with unresected metastatic colorectal cancer is controversial, and often performed only for palliation of symptoms. Our goal was to determine if resection of the primary tumor in this patient population is associated with improved survival. METHODS: This is a retrospective cohort study of the National Cancer Data Base from 2004 to 2012. The study population included all patients with synchronous metastatic colorectal adenocarcinoma who were treated with systemic chemotherapy. The study groups were patients who underwent definitive surgery for the primary tumor and those who did not. Patients were excluded if they had surgical intervention on the sites of metastasis or pathology other than adenocarcinoma. Primary outcome was overall survival. RESULTS: Of the 65,543 patients with unresected stage IV colorectal adenocarcinoma undergoing chemotherapy, 55% underwent surgical resection of the primary site. Patients who underwent surgical resection of the primary tumor had improved median survival compared to patients treated with chemotherapy alone (22 vs 13 months, p < .0001). The surgical survival benefit was present for patients who were treated with either multi-agent or single-agent chemotherapy (23 vs 14 months, p < 0.001; 19 vs 9 months, p < 0.001). Surgical resection of the primary tumor was also associated with improved survival when using multivariate analysis with propensity score matching (OR = 0.863; 95% CI [0.805-.924]; HR = 0.914; 95% CI [0.888-0.942]). CONCLUSIONS: Our results show that in patients with synchronous unresected stage IV colorectal adenocarcinoma undergoing single- or multi-agent chemotherapy, after adjusting for confounding variables, definitive resection of the primary site was associated with improved overall survival. Large randomized controlled trials are needed to determine if there is a causal relationship between surgery and increased overall survival in this patient population.
Authors: Al B Benson; Alan P Venook; Lynette Cederquist; Emily Chan; Yi-Jen Chen; Harry S Cooper; Dustin Deming; Paul F Engstrom; Peter C Enzinger; Alessandro Fichera; Jean L Grem; Axel Grothey; Howard S Hochster; Sarah Hoffe; Steven Hunt; Ahmed Kamel; Natalie Kirilcuk; Smitha Krishnamurthi; Wells A Messersmith; Mary F Mulcahy; James D Murphy; Steven Nurkin; Leonard Saltz; Sunil Sharma; David Shibata; John M Skibber; Constantinos T Sofocleous; Elena M Stoffel; Eden Stotsky-Himelfarb; Christopher G Willett; Christina S Wu; Kristina M Gregory; Deborah Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2017-03 Impact factor: 11.908
Authors: Nader N Massarweh; Linda T Li; Shubhada Sansgiry; David H Berger; Daniel A Anaya Journal: Ann Surg Oncol Date: 2016-01-19 Impact factor: 5.344
Authors: Femke J Amelung; Charlotte L J Mulder; Ivo A M J Broeders; Esther C J Consten; Werner A Draaisma Journal: Int J Colorectal Dis Date: 2016-11-12 Impact factor: 2.571
Authors: Brian C Gulack; Daniel P Nussbaum; Jeffrey E Keenan; Asvin M Ganapathi; Zhifei Sun; Mathias Worni; John Migaly; Christopher R Mantyh Journal: Dis Colon Rectum Date: 2016-04 Impact factor: 4.585
Authors: Constantinos Simillis; Eliana Kalakouti; Thalia Afxentiou; Christos Kontovounisios; Jason J Smith; David Cunningham; Michel Adamina; Paris P Tekkis Journal: World J Surg Date: 2019-07 Impact factor: 3.352