Incurable CRC: primary tumor resection modestly extends survival

  • Simillis C & al.
  • World J Surg
  • 22 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Resection of the primary tumor was associated with better OS and similar complication rates in patients with incurable colorectal cancer.

Why this matters

  • Modest survival improvement suggests primary tumor resection (PTR) should be considered on a case-by-case basis.

Study design

  • Meta-analysis of 77 studies (n=159,991).
  • Funding: None disclosed.

Key results

  • Mean OS:
    • Primary tumor intact (PTI) without chemotherapy, 4.02 months.
    • PTR without chemotherapy, 7.42 months.
    • PTI and chemotherapy, 14.30 months.
    • PTI and chemotherapy with bevacizumab, 17.27 months.
    • PTR and chemotherapy, 21.52 months.
    • PTR and chemotherapy with bevacizumab, 27.52 months.
  • PTR was associated with better OS compared with PTI (mean difference [MD], 7.46 months [P<.0001 hr>
  • PTR was also associated with longer cancer-specific survival (HR, 0.44 [P<.0001 md months pfs>
  • PTR:
    • Perioperative mortality, 4.5%.
    • 22.4% morbidity: major adverse events (10.2%), minor adverse events (18.5%), reoperation (2.5%), and intraabdominal collection/sepsis (2.2%).
  • PTI:
    • 21.7% morbidity.
  • Nonresective surgery:
    • 10.6% perioperative mortality, 21.7% morbidity.

Limitations

  • Most included studies were retrospective.

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