Surgical management of metastatic colon cancer: A population-based analysis

Metastasectomy has a curative potential in colon cancer, but its benefits have not been ascertained in population data. Our objective was to evaluate utilization of metastasectomy in colon cancer and its survival outcomes in groups defined by different age at diagnosis, tumor grade or varying extent of nodal spread.

We extracted data from the Surveillance, Epidemiology and End Results database on adult patients with stage IV colon cancer diagnosed between 2003 and 2011. We analyzed the association of overall survival (OS) with metastasectomy using multivariable Cox models.

Among 41,137 patients with stage IV cancer, 26,607 (65%) underwent primary surgery and 5028 (12.2%) underwent metastasectomy. Older patients were less likely to have ≥12 lymph nodes examined in the surgical specimen, but also less likely to have nodal metastases when adequately staged (from 86% for age <50 years to 79% for age ≥85 years). Metastasectomy was less common in older patients (from 18% for age <50 years to 7% for age ≥85 years). OS after resection was inversely associated with age and nodal involvement. The association of metastasectomy with survival was favorable in all age groups (hazard ratio, HR, 0.68-0.72, P<0.0001), but it was not significant for those ≥85y ears old (HR, 0.92, P=0.23). It was also favorable regardless of the extent of nodal spread or tumor grade.

Resection of metastatic site is favorably associated with survival in patients up to 85 years of age. Older patients undergoing metastasectomy are more likely to be node-negative when adequately staged.