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. 2020 Feb 20:25:14.
doi: 10.4103/jrms.JRMS_1056_18. eCollection 2020.

Does primary tumor resection contribute to overall survival in unresectable synchronous metastatic colorectal cancer?

Yakup Ergun  1 , Oznur Bal  1 , Mutlu Dogan  1 , Gokhan Ucar  1 , Merve Dirikoc  1 , Yusuf Acikgoz  1 , Ferhat Bacaksiz  2 , Dogan Uncu  1
Affiliations

Does primary tumor resection contribute to overall survival in unresectable synchronous metastatic colorectal cancer?

Yakup Ergun et al. J Res Med Sci. .

Abstract

Background: Primary tumor resection (PTR) in metastatic colorectal cancer (mCRC) has not been suggested by guidelines, since new systemic chemotherapy options have improved overall survival. However, the effect of PTR is still controversial in mCRC. In this study, we aimed to evaluate the effect of PTR on survival in unresectable mCRC.

Materials and methods: Two hundred and fifty-two patients with unresectable mCRC were screened retrospectively between January 2007 and December 2017 and a total of 147 patients who met inclusion criteria were included. The patients with emergency or elective PTR and the patients without surgery were compared for baseline features and overall survival.

Results: The median follow-up time was 15.6 months (range; 1.2-78.9) in whole patients. There were 91 patients in nonsurgical (NS) group and 56 patients in PTR group. The median overall survival was significantly longer in PTR group compared NS group (21.8 vs. 17.0 months, P = 0.01), but it was not associated to better overall survival in multivariate Cox analysis (hazard ratio: 0.65, 95% confidence interval: 0.41-1.02, P = 0.06). There was no significant difference in overall survival between emergency and elective surgery subgroups (22.9 vs. 16.1 months, respectively, P = 0.9).

Conclusion: PTR did not offer an overall survival benefit in this study. Although it is debated, we think that it is better to start treatment with chemotherapy and biological agent combinations in patients with asymptomatic mCRC. Thus, the patients can be protected from the morbidity and mortality of the surgery.

Keywords: Colectomy; colorectal cancer; metastatic; palliative surgery; survival.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve for overall survival in all patients
Figure 2
Figure 2
Kaplan–Meier curve for overall survival in emergency surgery and nonsurgical groups
Figure 3
Figure 3
Kaplan–Meier curve for overall survival in elective surgery and nonsurgical groups
See this image and copyright information in PMC

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