A Meta-Analysis to Determine the Effect of Primary Tumor Resection for Stage IV Colorectal Cancer with Unresectable Metastases on Patient Survival

Clancy, Cillian; Burke, John P.; Barry, Mitchel; Kalady, Matthew F.; Coffey, J. Calvin

doi:10.1245/s10434-014-3805-4

Cited by 118 publications

(102 citation statements)

References 36 publications

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“…An intact primary site might lead to more local symptoms such as pain, further contributing to the psychological burden of the disease. Retrospective studies have suggested a possible improvement in mortality if the primary tumour is resected in the setting of advanced disease 30,31 , and prospective studies are underway to evaluate the effect of resection on overall survival, progression-free survival, and quality of life 32 . Whether performing resections in patients with advanced crc will translate into a decreased risk of suicide has yet to be determined.…”

Section: Discussionmentioning

confidence: 99%

Risk and Predictors of Suicide in Colorectal Cancer Patients: A Surveillance, Epidemiology, and End Results Analysis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Risk and Predictors of Suicide in Colorectal Cancer Patients: A Surveillance, Epidemiology, and End Results Analysis

et al. 2017

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“…Nevertheless, the proportion of patients receiving colorectal surgery is higher than had been previously reported from population-based sources. 17 There are no prospective studies to support a benefit from colectomy in patients with uncomplicated primary colorectal tumors, and the role of surgery in patients with metastatic colorectal cancer is controversial, [18][19][20] and clinical experience has shown that patients who do not receive upfront surgery infrequently require subsequent symptom-directed intervention. 21 Our study's strengths include the large, population-based cohort of patients with advanced lung and colorectal cancer, who are representative of patients diagnosed with these cancers.…”

Section: Discussionmentioning

confidence: 99%

Intensity of Medical Interventions between Diagnosis and Death in Patients with Advanced Lung and Colorectal Cancer: A CanCORS Analysis

Brooks

Cronin

Uno

et al. 2016

Journal of Palliative Medicine

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Background: Medical interventions are an important component of the illness experience in advanced cancer. Objective: To describe the use of medical interventions between diagnosis and death in decedents with metastatic lung and colorectal cancer. Design: Retrospective analysis of a prospective cohort study. Setting/Subjects: We studied 1,840 decedents from the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Subjects had been diagnosed with stage IV lung or colorectal cancer between 2003 and 2005. Measurements: Hospitalizations, surgeries, radiation therapy treatments, chemotherapy treatments, and end-oflife care, reported by tertile of overall survival time.Results: Median survival in the bottom, middle, and top tertiles of survival was 1.2, 5.3, and 15.3 months for lung cancer, and 3.0, 18.0, and 44.4 months for colorectal cancer. Hospitalizations, chemotherapy receipt, and hospice enrollment increased with increasing survival. The median duration of chemotherapy in the top survival tertile was 149 days for lung cancer and 498 days for colorectal cancer. A minority of decedents used any hospice services, and the median duration of hospice enrollment exceeded 30 days only for enrollees in the top survival tertile (lung cancer, 35 days; colorectal cancer, 66 days). Conclusions: For patients with metastatic lung and colorectal cancer, longer survival is associated with increased intensity of medical care, characterized by greater use of chemotherapy and acute hospital care. Hospice utilization was uniformly low, and most hospice enrollees were referred to hospice in the last 30 days of life.

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“…When CRC is asymptomatic, the decision for surgery depends on the resectability of CRCLM. When CRCLM are non-resectable, the benefit of resection of the primary tumour without liver resection is debatable, although the results of a meta-analysis have shown a survival benefit [84]; however, data from this meta-analysis of non-randomized trials are questionable due to potential publication biases. Several RCTs have been started but most have not recruited a sufficient number of patients, and have been stopped prematurely [85].…”

Section: Surgery Of the Primary Tumourmentioning

confidence: 94%

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

Adam

Gramont

Figueras

et al. 2015

Cancer Treatment Reviews

471

413

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a b s t r a c tAn international panel of multidisciplinary experts convened to develop recommendations for managing patients with colorectal cancer (CRC) and synchronous liver metastases (CRCLM). A modified Delphi method was used. CRCLM is defined as liver metastases detected at or before diagnosis of the primary CRC. Early and late metachronous metastases are defined as those detected 612 months and >12 months after surgery, respectively. To provide information on potential curability, use of high-quality contrast-enhanced computed tomography (CT) before chemotherapy is recommended. Magnetic resonance imaging is increasingly being used preoperatively to aid detection of subcentimetric metastases, Contents lists available at ScienceDirectCancer Treatment Reviews j o u r n a l h o m e p a g e : w w w . e l s e v i e r h e a l t h . c o m / j o u r n a l s / c t r v and alongside CT in difficult situations. To evaluate operability, radiology should provide information on: nodule size and number, segmental localization and relationship with major vessels, response after neoadjuvant chemotherapy, non-tumoral liver condition and anticipated remnant liver volume. Pathological evaluation should assess response to preoperative chemotherapy for both the primary tumour and metastases, and provide information on the tumour, margin size and micrometastases. Although the treatment strategy depends on the clinical scenario, the consensus was for chemotherapy before surgery in most cases. When the primary CRC is asymptomatic, liver surgery may be performed first (reverse approach). When CRCLM are unresectable, the goal of preoperative chemotherapy is to downsize tumours to allow resection. Hepatic resection should not be denied to patients with stable disease after optimal chemotherapy, provided an adequate liver remnant with inflow and outflow preservation remains. All patients with synchronous CRCLM should be evaluated by a hepatobiliary multidisciplinary team.

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A Meta-Analysis to Determine the Effect of Primary Tumor Resection for Stage IV Colorectal Cancer with Unresectable Metastases on Patient Survival

Abstract: Resection of the primary tumor may confer a survival advantage in stage IV colorectal cancer with unresectable metastases but significant selection bias exists in current studies. Randomized controlled trials are essential to validate these findings.

Cited by 118 publications

References 36 publications

Risk and Predictors of Suicide in Colorectal Cancer Patients: A Surveillance, Epidemiology, and End Results Analysis

Risk and Predictors of Suicide in Colorectal Cancer Patients: A Surveillance, Epidemiology, and End Results Analysis

Intensity of Medical Interventions between Diagnosis and Death in Patients with Advanced Lung and Colorectal Cancer: A CanCORS Analysis

Managing synchronous liver metastases from colorectal cancer: A multidisciplinary international consensus

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