Primary Tumor Resection for Rectal Cancer With Unresectable Liver Metastases: A Chance to Cut Is a Chance for Improved Survival

Abstract

Background: About half of the patients with rectal cancer will develop liver metastasis during the course of their illness. Unfortunately, a large proportion of these metastases are unresectable. Surgical resection of the primary tumor vs. palliative treatment in patients with unresectable synchronous liver metastases remains controversial.Methods: Patients with rectal cancer with surgically unresectable liver metastases were identified from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010, to December 31, 2015. According to different treatment modalities, patients were divided into a primary tumor resection group and a non-resection group. Rates of primary tumor resection and survival were calculated for each year. Kaplan–Meier methods and Cox regression models were used to assess long-term survival. Multivariable logistic regression models were used to evaluate factors potentially associated with primary tumor resection.Results: Among 1,957 patients, 494 (25.2%) had undergone primary tumor resection. Patients with primary tumor resection had significantly better 5-year survival rate (27.2 vs. 5.6%, P < 0.001) compared to the non-resection group. Chemoradiotherapy with primary site resection was associated with the longest mean and 5-year OS (44.7 months, 32.4%). The Cox regression analyses of the subgroup indicated that patients who underwent primary tumor resection had improved survival compared with those who did not undergo resection in all 25 subgroups. Factors associated with primary tumor resection were well or moderately differentiated tumor grade, undergoing radiation, and primary tumor size <5 cm.Conclusions: The majority of patients with rectal cancer with unresectable liver metastases did not undergo primary tumor resection. Our results indicate that resection of the primary tumor appears to offer the greatest chance of survival. Prospective studies are needed to confirm these results.

The effect of primary tumour resection on patients with synchronous metastatic colorectal cancer treated with cetuximab‐containing regimens

“…In light of that, the survival advantage of PTR might be associated with the patient selection. 9 However, PTR+ and PTRÀ study groups had similar age and ECOG performance statuses in our study.…”

“…According to the other studies, patients with survival advantage of PTR were younger, and had better ECOG PS and tumour differentiation. In light of that, the survival advantage of PTR might be associated with the patient selection 9 . However, PTR+ and PTR− study groups had similar age and ECOG performance statuses in our study.…”

Survival benefit of primary tumor resection for gastric cancer with liver metastasis: A propensity score-matched, population-based study

“…survival time (31). Besides, medical costs and the quality of postoperative life should be considered before surgery (32).…”

“…Some opponents argue that resection of the primary tumor in metastasis tumor patients might delay the start of systemic therapy and increase postoperative complications, thus affecting survival time ( 31 ). Besides, medical costs and the quality of postoperative life should be considered before surgery ( 32 ).…”

Impact of Primary Tumor Resection on Survival of Patients with Metastatic Gallbladder Carcinoma: A Population-Based, Propensity‑Matched Study

“…However, the opponents of primary tumor resection in patients with distant metastasis argue that the procedure of local tumor resection can delay the initiation of systemic therapy and expose patients to possible postoperative complications, both of which can affect patient survival [ 45 ]. Therefore, multidisciplinary evaluation of patients with metastatic GBC should be routinely conducted before decision-making occurs [ 46 , 47 ], aiming to carefully establish personalized therapeutic strategies.…”