Surgery may not Be Necessary for Late-stage Colorectal Cancers

MAY 30, 2009
Christina T. Loguidice

Patients with stage IV colon cancer often undergo colon surgery immediately following their diagnosis to prevent symptoms and complications from their tumor, such as bowel obstruction, bleeding, and perforation, and then start chemotherapy 3 to 6 weeks later. Now, a new study from Memorial Sloan-Kettering Cancer Center (MSKCC) indicates that the majority of patients who present with stage IV colorectal cancer do not require immediate surgery to remove their primary tumor.

The study was a retrospective review that examined 233 metastatic colorectal cancer cases treated at MSKCC from 2000 to 2006. Patients were included if they were initially diagnosed with stage IV disease; there was no major bleeding, perforation, or obstruction of the colon; and the initial treatment was combination chemotherapy at MSKCC. Of the patients evaluated, 207 (89%) never developed colon problems that required urgent surgery, 10 (4%) developed colon obstruction that was successfully treated using a nonsurgical approach (stent placement or radiation), 16 (7%) required nonelective colon surgery for obstruction (n = 13) or perforation (n = 3); and 2 (0.8%) died secondary to surgical intervention; thus, the vast majority of patients (93%) of patients never required surgery to manage their primary tumor.

As a result of these findings, the investigators suggest the standard of practice for this patient population should be a nonsurgical approach, as it eliminates the costs and risks of colon surgery and allows the patient's metastatic disease--instead of just their primary tumor--to be treated without delay. Philip B. Patty, MD, a surgical oncologist at MSKCC and one of the study's lead authors, concluded “We now know that the routine use of surgery for these patients is based on old thinking, and we're beyond that. There will always be the need for individual exceptions based on the clinical situation, but our default position should be not to operate.”

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