When cancer has spread beyond the colon or rectum, the primary colorectal tumor can safely be left in place with only rare complications.
Surgeons at Memorial Sloan Kettering Cancer Center in New York followed 233 patients who began chemotherapy without surgery to remove their primary colon or rectal tumor. Almost 90 percent never had a problem with their tumor that needed intervention with surgery, radiation, or a stent. Only 7 percent required emergency surgery.
Researchers found among the group of 233:
- 16 patients (7 percent) needed emergency surgery because of an obstruction or bowel perforation.
- 10 patients (4 percent) had radiotherapy or a stent placed to relieve problems.
- 47 had the primary tumor removed at the same time they had surgery to remove metastastes.
- 8 had their colorectal tumor removed with surgery to place a pump in the abdomen to deliver chemo through the hepatic artery.
Use of Avastin, having a rectal tumor, or the number and size of metastatic tumors did not increase the risk of a complication in the primary tumor needing intervention.
Dr. George A. Poultsides and colleagues at Memorial Sloan Kettering concluded,
Most patients with synchronous, stage IV CRC who receive up-front modern combination chemotherapy never require palliative surgery for their intact primary tumor. These data support the use of chemotherapy, without routine prophylactic resection, as the appropriate standard practice for patients with neither obstructed nor hemorrhaging primary colorectal tumors in the setting of metastatic disease.
The study was also presented as a poster at ASCO 2009.
SOURCE: Poultsides et al., Journal of Clinical Oncology, Early Release, June 1, 2009.