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MODERN DAY PALLIATIVE CHEMOTHERAPY FOR METASTATIC COLORECTAL CANCER (MCRC) IN AN ASIAN POPULATION. DOES COLONIC RESECTION AFFECT SURVIVAL? AND A RETROSPECTIVE COHORT STUDY
Heidi S. Chang*1, Kai Yin Lee1, Joel Wen Liang Lau1, Yong Xiang Gwee2, Choon Seng Chong1
1University Surgical Cluster, National University Healthcare System, Singapore, Singapore; 2Yong Loo Lin School of Medicine, National University Of Singapore, Singapore, Singapore
Background:
Patients with mCRC and unresectable metastases on palliative chemotherapy at times undergo surgery for tumour crisis or semi-electively for symptomatic primary tumours (for example, bleeding or impending obstruction). This study aims to evaluate the role of colonic resection in this select group of patients, especially given the improved survival benefit offered by modern day chemotherapy.
Methods:
All patients diagnosed with mCRC and unresectable metastases on palliative chemotherapy from January 2004 to December 2014 were considered. Patients who received upfront tumour resection were excluded as they were likely to be selective for more favourable patient and disease factors. Patients who were on best supportive care or not fit for chemotherapy were also excluded as they likely selected for the worst performing group of patients. The primary outcome measure in this study was overall survival.
Results:
A total of 145 patients were included in our analysis. 58.6% (n= 85) of patients who received palliative chemotherapy never received surgery. 26.2% (n= 38) underwent primary tumour resection while 15.2% (n= 22) underwent creation of a diverting stoma. Patients who underwent primary tumour resection after initiating palliative chemotherapy had significantly longer overall survival (median 22.1 months p< 0.001) compared to patients who had a defunctioning stoma (median 9.9 months). Those who never received surgery (median 8.8 months) had the worst outcome. Overall survival was not affected by other variables such as age at diagnosis, comorbidities and type of metastases (solid organ vs peritoneal metastases).
Conclusions:
In this study, we found that patients with mCRC and unresectable metastases on palliative chemotherapy who had primary tumour resection had significantly longer overall survival than patients who did not. This is despite colonic resection being performed for indications such as palliation of symptoms or tumour crisis, rather than the possibility of overall survival benefit. In this highly selected cohort of patients, the survival benefit may be a result of decreased complications from the primary tumour (such as bleeding, obstruction, perforation) or selection bias that is inherent in the study design. Further prospective studies are required to confirm the observations of this study.
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