Elective palliative resection of incurable stage IV colorectal cancer: Who really benefits from it?

Costi, Roberta; Mauro, Davide Di; Veronesi, Licia; Ardizzoni, Andrea; Salcuni, P; Roncoroni, L; Sarli, Leopoldo; Violi, Vincenzo

doi:10.1007/s00595-009-4253-9

Cited by 21 publications

(13 citation statements)

References 42 publications

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“…Of twenty-three full-text articles that were excluded, twelve had no comparator nonsurgical group [27][28][29][30][31][32][33][34][35][36][37][38] ; four used a non-resection group (that is, ostomy procedures) as comparators [39][40][41][42] ; and another four used patients who underwent curative surgery as the comparator group [43][44][45][46] . Two studies, each with four comparator groups, provided minimal information about those groups, and one had a patient population that overlapped with the population of another study included in the present review 14,47 .…”

Section: Study Selectionmentioning

confidence: 99%

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

et al. 2013

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rate was 29.7% (95% ci: 18.5% to 41.0%), and the non-resection surgical procedures rate in the nonresection group was 27.6% (95 ci: 15.4% to 39.9%). No study provided qol data. ConclusionsAlthough this review supports primary tumour resection in advanced crc, the results have significant biases. Randomized trials are warranted to confirm the findings. KEY WORDSPrimary tumour resection, stage iv colorectal cancer, palliative surgery, survival INTRODUCTIONColorectal cancer (crc) is one of the leading causes of cancer death in North America 1 . The median overall survival of patients with stage iv crc managed with best supportive care alone is about 5-6 months 2 . Systemic therapy provides meaningful improvements in median survival and progression-free survival. Overall, with the judicious use of novel cytotoxic and biologic agents, the median overall survival of patients with stage iv crc has been extended to approximately 2 years [3][4][5] .The optimal surgical management of stage iv crc that is not amenable to curative resection is unknown. Although administration of systemic therapy in patients with stage iv crc may convert unresectable into resectable disease, the principal goal of treatment in most patients is to prolong survival, and only about 10%-15% patients are alive at 5 years. Consequently, in patients with stage iv crc, the potential morbidity of treatment and the treatment's impact on quality of life (qol) for the patient must be considered.Resection of the primary tumour in patients with stage iv cancer is often performed to deal with presenting primary tumour symptoms and ABSTRACT PurposeSurgical resection of the primary tumour in patients with advanced colorectal cancer (crc) remains controversial. This review compares survival in patients with advanced crc who underwent surgical resection of the primary tumour with that in patients not undergoing resection, and determines rates of postoperative mortality and nonfatal complications, the primary tumour complication rate, the non-resection surgical procedures rate, and quality of life (qol). MethodsReports in the central, medline, and embase databases were searched for relevant studies, which were selected using pre-specified eligibility criteria. The search was also restricted to publication dates from 1980 onward, the English language, and studies involving human subjects. Screening, evaluation of relevant articles, and data abstraction were performed in duplicate, and agreement between the abstractors was assessed. Articles that met the inclusion criteria were assessed for quality using the Newcastle-Ottawa Scale. Data were collected and synthesized per protocol. ResultsFrom among the 3379 reports located, fifteen retrospective observational studies were selected. Of the 12,416 patients in the selected studies, 8620 (69%) underwent surgery. Median survival was 15.2 months (range: 10-30.7 months) in the resection group and 11.4 months (range: 3-22 months) in the nonresection group. Hazard ratio for survival was 0.69 [95% confidence interval (ci): ...

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Section: Study Selectionmentioning

confidence: 99%

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

et al. 2013

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“…Controversy still exists concerning the patient who presents with advanced metastatic disease with an in situ primary tumor which itself provides very little in the way of symptoms. In these cases, most would still advocate primary excision where the response to neoadjuvant chemotherapy is a little unpredictable [111][112][113] and where there is a presumptive guess by the clinician of the likelihood of signi fi cant symptoms requiring semi-emergent surgery although the few studies available suggest that the likelihood of acute colorectal events necessitating urgent surgery are uncommon during the patient's life span [ 114 ] . Abstract Life expectancy has increased signifi cantly in recent years.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, the geriatric assessment in adjuvant colon cancer should follow three steps: 113 10 Adjuvant Therapy of Colorectal Cancer in Older People…”

Section: The Geriatric Assessmentmentioning

confidence: 99%

Management of Colorectal Cancers in Older People

Papamichael¹,

Audisio²

2013

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“…Some researchers have demonstrated that primary colectomy results in improved overall survival in patients with otherwise unresectable metastatic colon cancer and have been strong advocates of a surgical approach. 7,8 However, opponents point out that resection of the primary tumor in metastatic unresectable cases can certainly delay chemotherapy. 6,9 Other research has suggested that multiagent cytotoxic and biologic chemotherapy treatment alone does not compromise survival and asymptomatic patients should be spared noncurative surgical resection.…”

mentioning

confidence: 99%

Outcomes of colon resection in patients with metastatic colon cancer

Moghadamyeghaneh

Hanna

Hwang

et al. 2016

The American Journal of Surgery

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Elective palliative resection of incurable stage IV colorectal cancer: Who really benefits from it?

Abstract: An elderly age tends to be a contraindication to an elective primary tumor resection in patients affected by incurable CRC. Massive lymph node involvement and mucoid adenocarcinoma should also be considered before planning major colonic surgery.

Cited by 21 publications

References 42 publications

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

Should Noncurative Resection of the Primary Tumour Be Performed in Patients with Stage iv Colorectal Cancer? A Systematic Review and Meta-Analysis

Management of Colorectal Cancers in Older People

Outcomes of colon resection in patients with metastatic colon cancer

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