Modern-day palliative chemotherapy for metastatic colorectal cancer: does colonic resection affect survival?
BACKGROUND
Patients with metastatic colorectal cancer (mCRC) with surgically incurable metastases would be recommended for palliative chemotherapy (PC). The role of surgical intervention is debatable with no conclusive evidence for routine primary tumour resection (PTR) or stoma creation. We aimed to study if surgical intervention conferred a survival benefit in patients with mCRC who received upfront systemic therapy.


METHODS
A retrospective review of a prospectively collected database in a single centre was performed. Patients diagnosed with mCRC from January 2004 to December 2014 were included. We excluded patients who had an upfront surgical intervention, had no treatment with systemic therapy or had attained curative resection. The decision for surgery was based on the outcome of a multidisciplinary tumour board. Demographic, clinicopathological, treatment and follow-up data were collected. Univariate and multivariate analyses were performed.


RESULTS
Out of 408 patients with mCRC with incurable metastases, we analysed 124 patients who had upfront PC. Twenty-nine had PC + PTR (group A), 10 had PC + stoma (group B) and 85 had PC only (group C). Undergoing PTR led to significant improvement in overall survival (OS; 30.8 versus 13.4 versus 11.0 months, P < 0.001). With multivariate analysis, undergoing PTR and receiving biologics were independent good prognostic variables. Surgical resection was safe with minimal complications.


CONCLUSIONS
PTR was found to increase OS while stoma creation had no impact on OS. The benefits and safety of undergoing PTR may be a result of selection bias. Further prospective studies are required to confirm the observations of this study.
['Lau|Joel Wen Liang|JWL|0000-0002-7951-6338', 'Chang|Heidi Sian Ying|HSY|', 'Lee|Kai Yin|KY|', 'Gwee|Yong Xiang|YX|', 'Lee|Wen Qiang|WQ|', 'Chong|Choon Seng|CS|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000970:Antineoplastic Agents D000971:Antineoplastic Combined Chemotherapy Protocols D017024:Chemotherapy, Adjuvant D003082:Colectomy D015179:Colorectal Neoplasms D005260:Female D005500:Follow-Up Studies D006801:Humans D008113:Liver Neoplasms D008175:Lung Neoplasms D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D010166:Palliative Care D010534:Peritoneal Neoplasms D012189:Retrospective Studies D016019:Survival Analysis D016896:Treatment Outcome
chemotherapy colorectal cancer survival metastasis surgical stomas