No Benefit From Surgery for Metastatic Colon Cancer

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Surgeons who plan to operate to remove the original tumors from patients with metastatic colon cancer might do well to put down their scalpels and rely on chemotherapy instead, according to a new study.

Researchers at Memorial Sloan-Kettering Cancer Center in New York reviewed more than 200 cases and found that more than 90 percent of patients had no complications that required surgical intervention.

Of those who did require surgery, only two had complications leading to unsuccessful procedures.

"In this era of modern chemotherapy, routine surgery to remove the primary tumor in patients with unresectable metastases is no longer supported by the data," Dr. Philip Paty told colleagues at the American Society of Clinical Oncology meeting.

"In addition to being an unnecessary procedure that carries its own risks of morbidity and mortality, surgery delays the start of chemotherapy for several weeks, and in some cases may make the patient less fit for and less tolerant of chemotherapy," Paty said. "Unless there is an immediate need for surgery, patients should begin chemotherapy first."

About 147,000 Americans will be diagnosed with colorectal cancer this year, and almost 50,000 will die from the disease, according to the American Cancer Society.

These findings came from a retrospective analysis of 233 patients from a much smaller group who had metastatic colorectal cancer at diagnosis -- which means their cancers had spread beyond their original location.

The researchers wanted to find out whether a longstanding procedure -- removal of the primary tumor -- would matter once the cancer had spread.

All of the patients received a standard three-drug chemotherapy combination. In a subsequent follow-up, 217 patients (93 percent) had no complications that necessitated surgery for the primary tumor.

Of those, 55 eventually had elective surgery on the original tumor when surgeons removed lesions elsewhere, while eight others opted for it when surgeons implanted a hepatic-artery infusion-pump, a device that pumps chemotherapy medications directly into the liver.

For Colon Cancer, Surgery May Not Be Best Option

Of those who actually required surgery for primary tumor obstruction or perforation, 14 had successful procedures, suggesting that the delay posed little risk to the patients.

For the entire group, operative mortality -- the rate of death within 30 days of the surgery or while the patient is still hospitalized -- was 0.8 percent.

Paty reported no disclosures. Co-investigator Leonard Saltz reported relationships with Pfizer, Genentech, Bristol Myers, Imclone, Amgen and Roche. Co-investigator Nancy Kemeny reported relationships with Sanofi-Aventis and Pfizer.