How aggressive should we be in patients with stage iv colorectal cancer?

Kuo, Li Jen; Leu, Szu-Yun; Liu, Mei Ching; Jian, James Jer-Min; Cheng, Skye Hongiun; Chen, Chung-Ming

doi:10.1007/bf02660770

Cited by 56 publications

(44 citation statements)

References 27 publications

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“…1). In accordance with the prognostic factors most often reported to be related to survival, 4,8,11,[13][14][15][16][17][18][19][20][21][22][23][24] 15 variables were compared with respect to the outcome, expressed as (1) perioperative mortality and (2) median survival (Table 1). According to a parameter we recently found 25 to be related to prognosis of patients presenting incurable CRC at surgical exploration, the "metastatization pattern," patients were divided into as having a "local" (locally advanced) or a "systemic" (carcinosis/distant metastasis, regardless of local extension) disease.…”

Section: Patientsmentioning

confidence: 99%

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

et al. 2011

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Section: Patientsmentioning

confidence: 99%

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

et al. 2011

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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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“…The main argument in favour of resection is that it will prevent possible complications of the primary tumour, such as bleeding, obstruction or perforation [19][20][21]. Patients who receive initial systemic therapy without prior resection of the primary tumour are more likely to develop complications of the primary tumour [22].…”

Section: Introductionmentioning

confidence: 99%

The CAIRO4 study: The role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer—A randomized phase III study of the Dutch Colorectal Cancer Group (DCCG).

Wilt

Verhoef

Punt

et al. 2016

JCO

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Background: There is no consensus regarding resection of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastatic colorectal cancer (CRC). A potential benefit of resection of the primary tumour is to prevent complications of the primary tumour in later stages of the disease. We here propose a randomized trial in order to demonstrate that resection of the primary tumour improves overall survival. Methods/design:The CAIRO4 study is a multicentre, randomized, phase III study of the Dutch Colorectal Cancer Group (DCCG). Patients with synchronous unresectable metastases of CRC and few or absent symptoms of the primary tumour are randomized 1:1 between systemic therapy only, and resection of the primary tumour followed by systemic therapy. Systemic therapy will consist of fluoropyrimidine-based chemotherapy in combination with bevacizumab. The primary objective of this study is to determine the clinical benefit in terms of overall survival of initial resection of the primary tumour. Secondary endpoints include progression free survival, surgical morbidity, quality of life and the number of patients requiring resection of the primary tumour in the control arm. Discussion: The CAIRO4 study is a multicentre, randomized, phase III study that will assess the benefit of resection of the primary tumour in patients with synchronous metastatic CRC. Trial registration: The CAIRO4 study is registered at clinicaltrials.gov (NCT01606098)

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How aggressive should we be in patients with stage iv colorectal cancer?

Abstract: Whether to perform primary tumor resection in patients with asymptomatic Stage IV colorectal cancer remains controversial; however, the more aggressively we perform radical resection and metastasectomy to selected patients, the more survival benefits the patients obtain.

Cited by 56 publications

References 27 publications

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

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

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

The CAIRO4 study: The role of surgery of the primary tumour with few or absent symptoms in patients with synchronous unresectable metastases of colorectal cancer—A randomized phase III study of the Dutch Colorectal Cancer Group (DCCG).

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