J Korean Soc Coloproctol.  2011 Oct;27(5):226-230. 10.3393/jksc.2011.27.5.226.

Colorectal Cancer with Multiple Metastases: Is Palliative Surgery Needed?

• Choi HJ
• Shin JY

• KMID: 2198733
• DOI: http://doi.org/10.3393/jksc.2011.27.5.226

Abstract

In patients with symptomatic incurable metastatic colorectal cancer (mCRC), the goal of resection of the primary lesion is to palliate cancer-related morbidity, including obstruction, bleeding, or perforation. In patients with asymptomatic primary tumors and incurable metastatic disease, however, the necessity of primary tumor resection is less clear. Although several retrospective analyses suggest survival benefit in patients who undergo resection of the primary tumor, applying this older evidence to modern patients is out of date for several reasons. Modern chemotherapy regimens incorporating the novel cytotoxic agents oxaliplatin and irinotecan, as well as the target agents bevacizumab and cetuximab, have improved median survival from less than 1 year with the only available single-agent 5-fluorouracil until the mid-1990s to over 2 years. In addition to significant prolongation of overall survival, combinations of novel chemotherapeutic and target agents have allowed improved local and distant tumor control, decreasing the likelihood of local tumor-related complications requiring surgical resection. Resection of an asymptomatic primary tumor risks surgical complications and may postpone the administration of chemotherapy that may offer both systemic and local control. In conclusion, the morbidity and the mortality of unnecessary surgery or surgery that does not improve quality of life or survival in patients with mCRC of a limited life expectancy should be carefully evaluated. With the availability of effective combinations of chemotherapy and target agents, systemic therapy for the treatment of life-threatening metastases would be a preferable treatment strategy for unresectable asymptomatic patients with mCRC.

Keyword

Metastatic colorectal cancer; Palliative care; Chemotherapy

MeSH Terms

Antibodies, Monoclonal, Humanized
Bevacizumab
Camptothecin
Cetuximab
Colorectal Neoplasms
Cytotoxins
Fluorouracil
Hemorrhage
Humans
Life Expectancy
Neoplasm Metastasis
Organoplatinum Compounds
Palliative Care
Quality of Life
Retrospective Studies
Unnecessary Procedures
Antibodies, Monoclonal, Humanized
Camptothecin
Cytotoxins
Fluorouracil
Organoplatinum Compounds