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Modern‐day palliative chemotherapy for metastatic colorectal cancer: does colonic resection affect survival?
Author(s) -
Lau Joel Wen Liang,
Chang Heidi Sian Ying,
Lee Kai Yin,
Gwee Yong Xiang,
Lee Wen Qiang,
Chong Choon Seng
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14726
Subject(s) - medicine , colorectal cancer , univariate analysis , stoma (medicine) , multivariate analysis , surgery , chemotherapy , prospective cohort study , cancer , oncology
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.