Surgery Unnecessary for Most Patients with Metastatic Colorectal Cancer

Patients with newly diagnosed metastatic colorectal cancer do not need to undergo surgical removal of their tumor unless the tumor is causing complications, according to the results of a study presented at the 2009 Annual Meeting of the American Society of Clinical Oncology (ASCO) in Orlando, Florida.[1]

Colorectal cancer remains the second leading cause of cancer deaths in the United States. Metastatic colorectal cancer refers to cancer that has spread from the colon to distant sites in the body. Historically, standard treatment for metastatic colorectal cancer was removal of the primary tumor at the time of diagnosis. This was not to extend survival, but to prevent future complications that could be caused by the tumor.

However, many new chemotherapy drugs have proven effective in the treatment of metastatic colorectal cancer, and physicians have begun to speculate that surgical removal of the primary tumor is unnecessary and may carry more risk than benefit. Furthermore, immediate surgery often results in the delayed use of chemotherapy.

Researchers at Memorial Sloan-Kettering Cancer Center conducted a retrospective analysis of 233 consecutive patients diagnosed with metastatic colorectal cancer between 2000 and 2006 whose symptoms did not warrant immediate surgery. The patients were treated with one of three triple-drug regimens (FOLFOX, IFL, and FOLFIRI) with or without the addition of the targeted agent Avastin® (bevacizumab).

The results indicated that the majority of patients (93%) never developed complications that necessitated surgical removal of their tumor. The researchers concluded that most patients with metastatic colorectal cancer who receive immediate treatment with chemotherapy never require surgical removal of their tumor. They suggest that chemotherapy should be the standard of care for patients with metastatic colorectal cancer who do not have obstructed or bleeding colorectal tumors.


[1] Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract CRA4030.

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