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Impact of Palliative Chemotherapy and Surgery on Management of Stage IV Incurable Colorectal Cancer

Annals of Surgical Oncology volume 17, pages 432–440 (2010)Cite this article

Abstract

Background

Recent trials proposed chemotherapy (CHT) as the treatment of choice for patients affected by incurable colorectal cancer (ICRC). Nevertheless, surgery is still commonly offered to these patients. On the other hand, CHT is offered to ICRC patients regardless of the pattern of spread of the disease, local or distant, despite some evidence suggesting that metastatic pattern may influence the response to treatment.

Methods

A retrospective analysis was performed of 133 patients undergoing palliative treatment for ICRC from 1994 through 2007. Palliation consisted of surgery alone until 2002 and surgery with CHT (FOLFOX–FOLFIRI) thereafter. The impact of CHT and surgery was evaluated in the whole series as well as with respect to metastatic pattern (locally aggressive primary tumor and distant metastasis only), tumor site, and grading.

Results

Chemotherapy prolonged survival by 9 months (p = 0.001). In patients undergoing CHT, resective surgery did not prolong survival (p = 0.931), whereas in patients not undergoing CHT, it improved prognosis by 5 months (p = 0.023). Considering patients with distant metastasis only, CHT significantly prolonged survival (p < 0.001), whereas it did not improve the prognosis of patients with a locally aggressive primary tumor (p = 0.943). No difference in CHT effectiveness with respect to tumor site and grading was recorded.

Conclusions

CHT should be the preferred option in patients undergoing elective treatment for ICRC, whereas surgery should be considered whenever CHT is not administered. CHT significantly increases survival of patients with unresectable distant metastasis only, whereas it seems to be useless in patients with locally aggressive primary tumors.

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Acknowledgment

We acknowledge financial support from University of Parma Research Funds.

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Affiliations

  1. Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Dipartimento di Scienze Chirurgiche, Università di Parma, Parma, Italy

    Renato Costi PhD, Davide Di Mauro MD, Leopoldo Sarli MD, Luigi Roncoroni MD & Vincenzo Violi MD

  2. Service de Chirurgie Digestive et Viscérale, Hôpital Antoine Béclère, Clamart, France

    Renato Costi PhD

  3. Department of Colorectal Surgery, Whipps Cross University Hospital, London, UK

    Pasquale Giordano FRCS

  4. Dipartimento Polispecialistico 1, Unità Operativa di Oncologia Medica, Azienda Ospedaliera Universitaria di Parma, Parma, Italy

    Francesco Leonardi MD

  5. Dipartimento di Sanità Pubblica, Università di Parma, Parma, Italy

    Licia Veronesi MD

Authors
  1. Renato Costi PhD
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  2. Davide Di Mauro MD
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  3. Pasquale Giordano FRCS
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  4. Francesco Leonardi MD
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  5. Licia Veronesi MD
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  6. Leopoldo Sarli MD
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  7. Luigi Roncoroni MD
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  8. Vincenzo Violi MD
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Corresponding author

Correspondence to Renato Costi PhD.

Additional information

This paper was accepted for presentation as an abstract at the 4th Congress of the European Society of Coloproctology, Prague (Czech Republic), September 23–26, 2009.

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Costi, R., Di Mauro, D., Giordano, P. et al. Impact of Palliative Chemotherapy and Surgery on Management of Stage IV Incurable Colorectal Cancer. Ann Surg Oncol 17, 432–440 (2010). https://doi.org/10.1245/s10434-009-0830-9

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  • DOI: https://doi.org/10.1245/s10434-009-0830-9

Keywords

  • Primary Tumor Resection
  • Metastatic Pattern
  • Peritoneal Carcinosis
  • Incurable Stage
  • Unresectable Distant Metastasis