Constantinos Simillis1,2, Eliana Kalakouti3, Thalia Afxentiou4, Christos Kontovounisios3,5, Jason J Smith3,5, David Cunningham4, Michel Adamina6, Paris P Tekkis3,5,7. 1. Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, Twickenham Road, Isleworth, London, TW7 6AF, UK. csimillis@gmail.com. 2. Department of Surgery and Cancer, Imperial College, London, UK. csimillis@gmail.com. 3. Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, Twickenham Road, Isleworth, London, TW7 6AF, UK. 4. Department of Gastrointestinal Oncology, Royal Marsden Hospital, London, UK. 5. Department of Surgery and Cancer, Imperial College, London, UK. 6. Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland. 7. Department of Colorectal Surgery, Royal Marsden Hospital, London, UK.
Abstract
BACKGROUND: To assess the impact of primary tumor resection (PTR) on survival and morbidity in incurable colorectal cancer. METHODS: Systematic literature review and meta-analysis to compare PTR versus primary tumor intact (PTI). RESULTS: Seventy-seven studies were included, reporting on 159,991 participants (94,745 PTR; 65,246 PTI). PTR improved overall survival (hazard ratio [HR] 0.59, P < 0.0001; mean difference [MD] 7.27 months, P < 0.0001), cancer-specific survival (HR 0.47, MD 10.80), and progression-free survival (HR 0.76, MD 1.67). Overall survival remained significantly improved during subgroup analysis of asymptomatic patients (HR 0.69, MD 3.86), elderly patients (HR 0.46, MD 7.71), patients diagnosed after 2000 (HR 0.62, MD 7.29), patients with colon (HR 0.58, MD 6.31) or rectal (HR 0.54, MD 6.88) primary tumor, patients undergoing resection of primary tumor versus non-resectional surgery (NRS) to treat primary tumor complications (HR 0.56, MD 8.72), and of studies with propensity score analysis (HR 0.65, MD 5.68). Overall survival per treatment strategy was: [PTI/chemotherapy] 14.30 months, [PTI/bevacizumab] 17.27 months, [PTR/chemotherapy] 21.52 months, [PTR/bevacizumab] 27.52 months. PTR resulted in 4.5% perioperative mortality and 22.4% morbidity (major adverse events 10.2%, minor 18.5%, reoperation 2.5%, intraabdominal collection/sepsis 2.2%). PTI had 21.7% morbidity (obstruction 14.4%, anemia 11.0%, hemorrhage 1.5%, perforation 0.6%, adverse events requiring surgery 15.8%). NRS resulted in 10.6% perioperative mortality and 21.7% morbidity (major 7.9%, minor 21.7%, reoperation 0.1%). CONCLUSIONS: PTR in patients with incurable colorectal cancer results in a limited improvement of survival without a significant increase in morbidity. PTR should be considered by the multidisciplinary team on an individual patient basis.
BACKGROUND: To assess the impact of primary tumor resection (PTR) on survival and morbidity in incurable colorectal cancer. METHODS: Systematic literature review and meta-analysis to compare PTR versus primary tumor intact (PTI). RESULTS: Seventy-seven studies were included, reporting on 159,991 participants (94,745 PTR; 65,246 PTI). PTR improved overall survival (hazard ratio [HR] 0.59, P < 0.0001; mean difference [MD] 7.27 months, P < 0.0001), cancer-specific survival (HR 0.47, MD 10.80), and progression-free survival (HR 0.76, MD 1.67). Overall survival remained significantly improved during subgroup analysis of asymptomatic patients (HR 0.69, MD 3.86), elderly patients (HR 0.46, MD 7.71), patients diagnosed after 2000 (HR 0.62, MD 7.29), patients with colon (HR 0.58, MD 6.31) or rectal (HR 0.54, MD 6.88) primary tumor, patients undergoing resection of primary tumor versus non-resectional surgery (NRS) to treat primary tumor complications (HR 0.56, MD 8.72), and of studies with propensity score analysis (HR 0.65, MD 5.68). Overall survival per treatment strategy was: [PTI/chemotherapy] 14.30 months, [PTI/bevacizumab] 17.27 months, [PTR/chemotherapy] 21.52 months, [PTR/bevacizumab] 27.52 months. PTR resulted in 4.5% perioperative mortality and 22.4% morbidity (major adverse events 10.2%, minor 18.5%, reoperation 2.5%, intraabdominal collection/sepsis 2.2%). PTI had 21.7% morbidity (obstruction 14.4%, anemia 11.0%, hemorrhage 1.5%, perforation 0.6%, adverse events requiring surgery 15.8%). NRS resulted in 10.6% perioperative mortality and 21.7% morbidity (major 7.9%, minor 21.7%, reoperation 0.1%). CONCLUSIONS: PTR in patients with incurable colorectal cancer results in a limited improvement of survival without a significant increase in morbidity. PTR should be considered by the multidisciplinary team on an individual patient basis.
Authors: Gillian Gresham; Daniel J Renouf; Matthew Chan; Hagen F Kennecke; Howard J Lim; Carl Brown; Winson Y Cheung Journal: Ann Surg Oncol Date: 2014-05-24 Impact factor: 5.344
Authors: Chao-Nan Qian; Bree Berghuis; Galia Tsarfaty; MaryBeth Bruch; Eric J Kort; Jon Ditlev; Ilan Tsarfaty; Eric Hudson; David G Jackson; David Petillo; Jindong Chen; James H Resau; Bin Tean Teh Journal: Cancer Res Date: 2006-10-23 Impact factor: 12.701
Authors: Ruba A Hamed; Sam Marks; Helen Mcelligott; Roshni Kalachand; Hawa Ibrahim; Said Atyani; Greg Korpanty; Nemer Osman Journal: Mol Clin Oncol Date: 2021-12-21
Authors: Seung-Seop Yeom; Soo Young Lee; Han Deok Kwak; Chang Hyun Kim; Young Jin Kim; Hyeong Rok Kim Journal: Medicine (Baltimore) Date: 2020-02 Impact factor: 1.817