Progressive Oncological Surgery Is Associated with Increased Curative Resection Rates and Improved Survival in Metastatic Colorectal Cancer

Abstract

Background: Secondary resection rates in first-line chemotherapy trials for metastatic colorectal cancer (mCRC) remain below 15%, representing a clear contrast to reports by specialised surgical centres, where progressive liver, peritoneal-surface, and pulmonary surgery increased access to curative-intent treatment. We present a long-term evaluation of oncosurgical management in a single-centre, analysing the aggregate effect of gradual implementation of surgical subspecialties and systemic treatments on mCRC patients’ resection rates and prognosis. Methods: Patients with newly diagnosed mCRC from 2003 to 2014 were retrospectively categorised into palliative treatment (PAT) and curative intent surgery (CIS) and three time periods were analysed for treatment changes and factors associated with survival. Results: Four hundred-twenty patients were treated (PAT:250/CIS:170). Over time periods, the number of presenting patients remained consistent, whereas curative resection rates increased from 29% to 55%, facilitated by an increment of patients undergoing hepatectomy (21 to 35%), pulmonary surgery (6 to 17%), and peritonectomy/intraoperative chemotherapy (0 to 8%). Also, recently, significantly more multi-line systemic treatments were applied. The median survival markedly improved from 21.9 months (2003–2006; 95% confidence interval (CI) 17.3–26.5) to 36.5 months (2011–2014; 95% CI 26.6–46.4; p = 0.018). PAT was a significant factor of poor survival and diagnosis of mCRC in the latest time period was independently associated with a distinctly lower risk for palliative treatment (odds ratio 0.15). Conclusions: In modern eras of medical oncology, achieving appropriate resection rates through utilization of state-of-the-art oncological surgery by dedicated experts represents a cornerstone for long-term survival in mCRC.

Recellularized Colorectal Cancer Patient-Derived Scaffolds as In Vitro Pre-Clinical 3D Model for Drug Screening

“…where N is the number of experimental data acquired, H i,exp the experimental value obtained at time t i , and H(t i ) is its estimation through Equation (2). Each sample was then characterized by the specific value of permeability found from the fitting.…”

“…Nowadays, surgery is a curative treatment for these patients, but 40 to 50% who undergo surgery alone, ultimately relapse and die of metastatic disease [2][3][4]. In this context, it is important to know that patients with high-risk stage II and stage III colon cancer are randomly assigned to receive an adjuvant treatment in order to reduce recurrence and metastasis formation [5].…”

MicroRNA‑758 acts as a tumor inhibitor in colorectal cancer through targeting PAX6 and regulating PI3K/AKT pathway

“…Surgical treatment is still the first choice for the radical treatment of CRC. However, despite the rapid development of surgical techniques, the surgical cure rate and the 5-year survival rate of CRC patients have been hovering around 50% (2). The recurrence of cancer in liver, lung or peritoneal is one of the causes of CRC treatment failure (3).…”

Colorectal Cancer Research: Basic, Preclinical, and Clinical Approaches

“…These mechanisms include the transcriptional regulation of DNA repair proteins [8]; the epigenetic regulation of the zinc finger E-box-binding homeobox 1 [9] and the expression of the (pro)renin receptor [10], , and calcium and calcium-activated potassium channels [12]; the contribution of immune cells in the tumor microenvironment [13]; and the identification of genetic aberrations that occur during the transition from adenoma to carcinoma [14]. The development of tools for preclinical research is also a key research area, such as the establishment of tumor models at the individual patient level [15] and the refinement of clinical approaches for improving the survival of patients with metastatic colorectal cancer [16][17][18][19].Review articles have summarized the latest developments of clinical issues related to the management of improving chemotherapeutic approaches for metastatic colorectal cancer [20][21][22], the characterization of the hallmarks of serrated colorectal lesions [23] and immune-mediated intestinal disorders that can be associated with small bowel carcinoma [24], as well as the current state of knowledge of specific facets of colorectal cancer research such as oncogenic tyrosine kinase signaling [25], integrin α6β4 [26], and epigenetic mechanisms by which long non-coding RNAs regulate gene expression [27].The variety of the content of this Special Issue devoted to colorectal cancer illustrates the need for investigating the cellular basis of this disease from every angle in order to develop efficient screening and treatment strategies that can significantly impact the quality of life of the patients. I would like to thank all of the authors that have contributed to the articles of this Special Issue for their work.…”

“…These mechanisms include the transcriptional regulation of DNA repair proteins [8]; the epigenetic regulation of the zinc finger E-box-binding homeobox 1 [9] and the expression of the (pro)renin receptor [10], , and calcium and calcium-activated potassium channels [12]; the contribution of immune cells in the tumor microenvironment [13]; and the identification of genetic aberrations that occur during the transition from adenoma to carcinoma [14]. The development of tools for preclinical research is also a key research area, such as the establishment of tumor models at the individual patient level [15] and the refinement of clinical approaches for improving the survival of patients with metastatic colorectal cancer [16][17][18][19].…”