Surgery extends life for metastatic colorectal cancer patients

By Sarah Guy, medwireNews Reporter

Individuals with colorectal cancer that has metastasized to the liver or lung live longer after curative surgery plus chemotherapy than their counterparts who receive palliative chemotherapy alone, report researchers.

The findings should encourage the use of palliative surgery in this population, writes the team in the British Journal of Cancer, rather than relying on chemotherapy as the standard approach.

Younger patients and those with two or fewer metastases showed the greatest benefit in survival with palliative resection, suggesting the need for careful selection of patients who receive this treatment.

"Clearly, only patients who would benefit from palliative resection should be considered for this procedure," say Tae-You Kim (Seoul National University, Republic of Korea) and colleagues.

The team analyzed data for 1015 mCRC patients aged 16 to 88 years who were treated between 2000 and 2009 and had an overall survival (OS) time of 21 months. The most common site for metastatic disease was the liver, at 58%.

In all, 168 (16.5%) patients underwent a metastasectomy with curative intent; on the liver in 86% of cases and on the lung in 16%. Median OS was 83 months. A total of 158 (94%) of these patients received chemotherapy after their surgery.

Kim and co-workers report a significant difference in the median progression-free survival time for those who received surgery in addition to chemotherapy, at a respective 7.7 versus 6.6 months for those who did not receive surgery.

The median OS among patients who received palliative resection was significantly longer than that for patients who did not, at 21.4 versus 14.1 months, respectively.

Of the remaining patients who did not undergo surgery, 87% were treated with chemotherapy, with oxaliplatin the most commonly used agent.

Multivariate analysis revealed a significant 1.67 hazard ratio for death during the 10-year study period for patients with three or more metastatic sites compared with those who had one or two sites of metastasis.

Being aged 61 years or older also reduced OS, giving a hazard ratio of 1.25 for death.

The researchers suggest that when performing palliative resection, "postoperative morbidity and mortality should be considered."

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