43 - Freie Mitteilung
16. Mai 2019, 08:30 - 10:00, Szenario 1, 5. OG
Primary tumour resection in patients with incurable colorectal cancer
C. Gingert1, C. Simillis2, E. Kalakouti2, T. Afxentiou2, D. Cunningham2, M. Adamina1, P. Tekkis2, Presenter: C. Gingert1 (1Winterthur, 2London/UK)
At diagnosis, about 1 in 4 patients with colorectal cancer present with synchronous metastases, which are unresectable in 75% of these patients. An important question which remains unanswered for those patients is whether the best treatment strategy is primary tumour resection (PTR) with chemotherapy, or immediate chemotherapy without PTR.
A systematic literature review and meta-analysis was performed to compare survival and adverse events in patients with incurable colorectal cancer undergoing PTR versus primary tumour intact (PTI), both including modern chemotherapy regimen. An inverse-variance random-effects model was used for the meta-analysis.
75 studies were included, reporting on 129’994 participants (82’951 PTR; 47’043 PTI). PTR increased overall survival (hazard ratio [HR] 0∙58, P<0∙0001) by 7∙5 months (mean difference [MD] 7∙53 months, P<0∙0001) compared to PTI. PTR resulted in longer cancer-specific survival (HR 0∙44, P<0∙0001; MD 10∙01, P<0∙0001) and progression-free survival (HR 0∙75, P<0∙0001; MD 1∙70, P<0∙0001). PTR also improved overall survival during subgroup analysis of: patients receiving chemotherapy (HR 0∙57, P<0∙0001; MD 7∙27, P<0∙0001), patients receiving bevacizumab (HR 0∙56, P=0∙05; MD 10∙56, P=0∙01), elderly patients (HR 0∙46, P<0∙0001; MD 8∙72, P<0∙0001), asymptomatic patients (HR 0∙66, P<0∙0001; MD 3∙86, P=0∙002), studies with propensity analysis (HR 0∙62, P<0∙0001; MD 5∙68, P=0∙0003). PTR had 4∙5% perioperative mortality and 22∙4% morbidity (major adverse events 10∙2%, minor 18∙5%, reoperation 2∙5%, intraabdominal collection/sepsis 2∙2%, anastomotic leak 1∙6%). PTI was associated with 21∙7% morbidity (obstruction 14∙4%, anaemia 11∙0%, haemorrhage 1∙5%, perforation 0.6%, adverse events requiring surgery 15∙8%). Non-resectional surgery resulted in 10∙6% perioperative mortality and 21∙7% morbidity (major 7∙9%, minor 21∙7%, reoperation 0∙1%).
PTR in patients with incurable colorectal cancer results in an appreciable improvement of survival without a significant increase in overall complications. PTR should be considered by the multidisciplinary team on an individual patient basis.