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Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone.

Publication ,  Journal Article
Gulack, BC; Nussbaum, DP; Keenan, JE; Ganapathi, AM; Sun, Z; Worni, M; Migaly, J; Mantyh, CR
Published in: Dis Colon Rectum
April 2016

BACKGROUND: Controversy exists over whether resection of the primary tumor in stage IV colorectal cancer with inoperable metastases improves patient outcomes. OBJECTIVE: The purpose of this study was to evaluate whether resection of the primary tumor without metastasectomy in patients with stage IV colorectal cancer is associated with improved overall survival compared with patients undergoing chemotherapy and/or radiation therapy alone. DESIGN: This was a retrospective review of a multi-institutional dataset. SETTINGS: This study was conducted in all participating commission on cancer (CoC)-accredited facilities. PATIENTS: The 2003-2006 National Cancer Data Base was reviewed to identify patients with stage IV adenocarcinoma of the colon or rectum who underwent palliative treatment without curative intent, either in the form of surgical resection of the primary tumor without metastasectomy consisting of a colectomy or rectal resection with or without chemotherapy and/or radiation or chemotherapy and/or radiation alone. MAIN OUTCOME MEASURES: Groups were compared for baseline characteristics. Overall survival was compared using Kaplan-Meier analysis before and after propensity matching with a 1:1 nearest-neighbor algorithm. RESULTS: Of the 1446 patients included in the analysis, 231 (16%) underwent surgical resection of the primary tumor without metastasectomy. Surgical resection was associated with a significant survival benefit on unadjusted analysis (median survival, 9.2 vs. 7.6 months; p < 0.01). After propensity matching to adjust for nonrandom treatment selection, surgical resection continued to be associated with a significant survival benefit (median survival, 9.2 vs. 7.3 months; p < 0.01). LIMITATIONS: This study was limited by the potential for selection bias regarding which patients received surgical resection. There was also a lack of data regarding the indication for operation, specifically whether a patient was symptomatic or asymptomatic before resection. The inability to account for tumor size or grade among patients who did not receive surgical resection was another limitation. CONCLUSIONS: Surgical resection of the primary tumor without metastasectomy in patients with metastatic colorectal cancer is associated with improved survival as compared with chemotherapy/radiation therapy alone. Additional research is necessary to determine which patients may benefit from this intervention.

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Published In

Dis Colon Rectum

DOI

EISSN

1530-0358

Publication Date

April 2016

Volume

59

Issue

4

Start / End Page

299 / 305

Location

United States

Related Subject Headings

  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Rectum
  • Palliative Care
  • Neoplasm Staging
  • Neoplasm Metastasis
  • Multivariate Analysis
  • Middle Aged
  • Male
 

Citation

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Gulack, B. C., Nussbaum, D. P., Keenan, J. E., Ganapathi, A. M., Sun, Z., Worni, M., … Mantyh, C. R. (2016). Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone. Dis Colon Rectum, 59(4), 299–305. https://doi.org/10.1097/DCR.0000000000000546
Gulack, Brian C., Daniel P. Nussbaum, Jeffrey E. Keenan, Asvin M. Ganapathi, Zhifei Sun, Mathias Worni, John Migaly, and Christopher R. Mantyh. “Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone.Dis Colon Rectum 59, no. 4 (April 2016): 299–305. https://doi.org/10.1097/DCR.0000000000000546.
Gulack, Brian C., et al. “Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone.Dis Colon Rectum, vol. 59, no. 4, Apr. 2016, pp. 299–305. Pubmed, doi:10.1097/DCR.0000000000000546.
Gulack BC, Nussbaum DP, Keenan JE, Ganapathi AM, Sun Z, Worni M, Migaly J, Mantyh CR. Surgical Resection of the Primary Tumor in Stage IV Colorectal Cancer Without Metastasectomy is Associated With Improved Overall Survival Compared With Chemotherapy/Radiation Therapy Alone. Dis Colon Rectum. 2016 Apr;59(4):299–305.

Published In

Dis Colon Rectum

DOI

EISSN

1530-0358

Publication Date

April 2016

Volume

59

Issue

4

Start / End Page

299 / 305

Location

United States

Related Subject Headings

  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Rectum
  • Palliative Care
  • Neoplasm Staging
  • Neoplasm Metastasis
  • Multivariate Analysis
  • Middle Aged
  • Male