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. 2019 Feb 14;11(2):218.
doi: 10.3390/cancers11020218.

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

Florian Primavesi  1   2 , Stefan Stättner  3   4 , Tarkan Jäger  5 , Georg Göbel  6 , Jaroslav Presl  7 , Katerina Tomanová  8 , Selina Buchner  9 , Manuel Maglione  10 , Thomas Resch  11 , Jörg Hutter  12 , Dietmar Öfner  13   14 , Adam Dinnewitzer  15
Affiliations

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

Florian Primavesi et al. Cancers (Basel). .

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.

Keywords: advances in management; colorectal cancer; curative intent; liver resection; metastases; modern chemotherapy; peritoneal surface surgery; pulmonary resection; resectability; surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Kaplan–Meier curves of overall survival (OS; months) comparing curative (CIS) and palliative (PAT) patients (p < 0.001). (B) Comparison of OS in the three study periods (p = 0.018).
Figure 2
Figure 2
Kaplan–Meier curves of overall survival (months) comparing the three study periods in (A) curative (CIS; p = 0.053) and (B) palliative (PAT) patients (p = 0.080).
Figure 3
Figure 3
(A) Percentage of patients per period with curative-intent surgery (green) and palliative treatment (blue; p < 0.001). (B) Percentage of patients undergoing liver resection per period (blue = no liver resection; green = minor resection; beige = major resection (p = 0.010).
See this image and copyright information in PMC

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