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Benefit of Surgical Resection of the Primary Tumor in Patients Undergoing Chemotherapy for Stage IV Colorectal Cancer with Unresected Metastasis

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

Resection of the primary tumor in patients with unresected metastatic colorectal cancer is controversial, and often performed only for palliation of symptoms. Our goal was to determine if resection of the primary tumor in this patient population is associated with improved survival.

Methods

This is a retrospective cohort study of the National Cancer Data Base from 2004 to 2012. The study population included all patients with synchronous metastatic colorectal adenocarcinoma who were treated with systemic chemotherapy. The study groups were patients who underwent definitive surgery for the primary tumor and those who did not. Patients were excluded if they had surgical intervention on the sites of metastasis or pathology other than adenocarcinoma. Primary outcome was overall survival.

Results

Of the 65,543 patients with unresected stage IV colorectal adenocarcinoma undergoing chemotherapy, 55% underwent surgical resection of the primary site. Patients who underwent surgical resection of the primary tumor had improved median survival compared to patients treated with chemotherapy alone (22 vs 13 months, p < .0001). The surgical survival benefit was present for patients who were treated with either multi-agent or single-agent chemotherapy (23 vs 14 months, p < 0.001; 19 vs 9 months, p < 0.001). Surgical resection of the primary tumor was also associated with improved survival when using multivariate analysis with propensity score matching (OR = 0.863; 95% CI [0.805–.924]; HR = 0.914; 95% CI [0.888–0.942]).

Conclusions

Our results show that in patients with synchronous unresected stage IV colorectal adenocarcinoma undergoing single- or multi-agent chemotherapy, after adjusting for confounding variables, definitive resection of the primary site was associated with improved overall survival. Large randomized controlled trials are needed to determine if there is a causal relationship between surgery and increased overall survival in this patient population.

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Authors and Affiliations

  1. Department of Surgery, Loma Linda University Health, 11175 Campus Street, Suite 21108, Loma Linda, CA, 92350, USA

    Sean Maroney

  2. Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA

    Carlos Chavez de Paz

  3. Department of Surgery, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, 92354, USA

    Mark E. Reeves, Carlos Garberoglio, Elizabeth Raskin, Maheswari Senthil, Jukes P. Namm & Naveenraj Solomon

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  1. Sean Maroney
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  2. Carlos Chavez de Paz
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  3. Mark E. Reeves
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  4. Carlos Garberoglio
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  5. Elizabeth Raskin
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  6. Maheswari Senthil
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  7. Jukes P. Namm
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  8. Naveenraj Solomon
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Contributions

All authors listed have made substantial contributions to the conception and design of this manuscript, including analysis and interpretation of data, revising the draft, and have approved the final version as it is now submitted. They are in agreement that they are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Sean Maroney.

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Maroney, S., de Paz, C.C., Reeves, M.E. et al. Benefit of Surgical Resection of the Primary Tumor in Patients Undergoing Chemotherapy for Stage IV Colorectal Cancer with Unresected Metastasis. J Gastrointest Surg 22, 460–466 (2018). https://doi.org/10.1007/s11605-017-3617-5

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  • DOI: https://doi.org/10.1007/s11605-017-3617-5

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