Primary Tumor Resection in Patients with Incurable Localized or Metastatic Colorectal Cancer: A Systematic Review and...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Colorectal cancer (CRC) poses a significant global health challenge.
• Management of incurable CRC requires careful consideration of treatment strategies.
• The role of primary tumor resection (PTR) in incurable CRC remains a subject of investigation.

Purpose of the Study:

• To evaluate the impact of primary tumor resection (PTR) on survival outcomes in patients with incurable colorectal cancer.
• To assess the associated morbidity and mortality rates following PTR.
• To compare PTR with non-resectional approaches for primary tumor management in this patient population.

Main Methods:

• A systematic literature review and meta-analysis were conducted.
• Studies comparing PTR versus primary tumor intact (PTI) were included.
• Seventy-seven studies encompassing 159,991 participants were analyzed.

Main Results:

• PTR significantly improved overall survival (HR 0.59), cancer-specific survival (HR 0.47), and progression-free survival (HR 0.76).
• Survival benefits were observed across various subgroups, including asymptomatic and elderly patients.
• PTR demonstrated a perioperative mortality of 4.5% and morbidity of 22.4%, compared to 21.7% for PTI and 21.7% for non-resectional surgery (NRS).

Conclusions:

• Primary tumor resection offers a limited survival improvement in incurable colorectal cancer without a significant increase in morbidity.
• The decision for PTR should be individualized and made by a multidisciplinary team.
• Further research may refine patient selection for PTR in advanced colorectal cancer.