NEWS & VIEWS SURGERY
Palliative primary tumour resection in mCRC—debate continues Cornelis J. H. van de Velde
Debate continues regarding the benefit of primary tumour resection for patients with asymptomatic metastatic colorectal cancer; the largest observational study conducted to date has demonstrated prolonged survival, but was probably subject to biases, and data from previous meta-analyses of observational data are contradictory. The results of two ongoing randomized trials are eagerly awaited. In the meantime, treatment should be directed at symptom palliation. van de Velde, C. J. H. Nat. Rev. Clin. Oncol. advance online publication 20 January 2015; doi:10.1038/nrclinonc.2015.7
Worldwide, the incidence of colorectal cancer (CRC) continues to increase; approximately 20–25% of patients present with metastatic (stage IV) disease, and roughly another 25% will develop metastases in the follow-up period after initial treatment. Survival of patients with metastatic CRC (mCRC) has improved in the past decade, mainly as a result of more-effective chemo therapy regimens. Obviously, surgical resection of the primary tumour and all metastatic disease also improves survival; however, for most patients with stage IV CRC, complete surgical removal of all metastatic disease is not an option. Despite many (observational) studies and systematic reviews, the potential survival benefit of primary tumour resection for patients with asymptomatic incurable mCRC
remains the subject of intense debate and, therefore, this treatment approach is currently controversial.1,2 Tarantino and co-authors1 recently contributed to this discussion by reporting the largest observational study conducted to date. They analysed the populationbased Surveillance, Epidemiology, and End Results (SEER) data from 37,793 patients with mCRC to assess whether palliative resection of the primary tumour without removal of metastases, as performed in 23,004 (60.9%) of the patients studied, resulted in improved overall and cancerspecific survival. 1 The study found that the rate of patients undergoing a primary tumour resection decreased from 68.4% in 1998 to 50.7% in 2009 (P
Palliative primary tumour resection in mCRC—debate continues Cornelis J. H. van de Velde
Debate continues regarding the benefit of primary tumour resection for patients with asymptomatic metastatic colorectal cancer; the largest observational study conducted to date has demonstrated prolonged survival, but was probably subject to biases, and data from previous meta-analyses of observational data are contradictory. The results of two ongoing randomized trials are eagerly awaited. In the meantime, treatment should be directed at symptom palliation. van de Velde, C. J. H. Nat. Rev. Clin. Oncol. advance online publication 20 January 2015; doi:10.1038/nrclinonc.2015.7
Worldwide, the incidence of colorectal cancer (CRC) continues to increase; approximately 20–25% of patients present with metastatic (stage IV) disease, and roughly another 25% will develop metastases in the follow-up period after initial treatment. Survival of patients with metastatic CRC (mCRC) has improved in the past decade, mainly as a result of more-effective chemo therapy regimens. Obviously, surgical resection of the primary tumour and all metastatic disease also improves survival; however, for most patients with stage IV CRC, complete surgical removal of all metastatic disease is not an option. Despite many (observational) studies and systematic reviews, the potential survival benefit of primary tumour resection for patients with asymptomatic incurable mCRC
remains the subject of intense debate and, therefore, this treatment approach is currently controversial.1,2 Tarantino and co-authors1 recently contributed to this discussion by reporting the largest observational study conducted to date. They analysed the populationbased Surveillance, Epidemiology, and End Results (SEER) data from 37,793 patients with mCRC to assess whether palliative resection of the primary tumour without removal of metastases, as performed in 23,004 (60.9%) of the patients studied, resulted in improved overall and cancerspecific survival. 1 The study found that the rate of patients undergoing a primary tumour resection decreased from 68.4% in 1998 to 50.7% in 2009 (P
