Editorial
Value of Tumour Resection in Colorectal Cancer With Unresectable Metastases
Valor de la resección tumoral en el cáncer colorrectal con metástasis irresecables
Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
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Allaix, Marco G. Patti" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Marco E." "apellidos" => "Allaix" ] 1 => array:2 [ "nombre" => "Marco G." "apellidos" => "Patti" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X1300064X" "doi" => "10.1016/j.ciresp.2013.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X1300064X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507713002056?idApp=UINPBA00004N" "url" => "/21735077/0000009100000006/v1_201312060036/S2173507713002056/v1_201312060036/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Value of Tumour Resection in Colorectal Cancer With Unresectable Metastases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "351" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sebastiano Biondo, Ricardo Frago" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Sebastiano" "apellidos" => "Biondo" "email" => array:1 [ 0 => "sbn.biondo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Frago" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, IDIBELL, Universidad de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor de la resección tumoral en el cáncer colorrectal con metástasis irresecables" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In spite of the lack of scientific evidence, the resection of primary tumors in asymptomatic patients with colorectal cancer (CRC) with unresectable synchronous metastases was a common practice in many centers until the mid-1990s. This method was able to control any possible complications derived from the primary tumor, which occurred in about 20% of patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Nonetheless, after the implementation of new chemotherapy drugs and the improvement in overall survival of patients with stage IV CRC, current publications, as well as the American Society of Clinical Oncology (ASCO), advocate chemotherapy as initial treatment for these patients, reserving surgery for patients with symptoms derived from the primary tumor or with risk of intestinal obstruction.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This change in treatment strategy is based on the fact that chemotherapy has beneficial effects not only on metastatic disease but also on the primary tumor.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In this way, the number of complications related with the primary tumor has been seen to decrease to about 7%.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The effect of chemotherapy on survival becomes apparent when we compare the periods of treatment when only fluoropyrimidines were used with current treatment regimes, after the implementation of modern chemotherapy drugs (oxaliplatin or irinotecan) and biological agents (bevacizumab, cetuximab).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Some recent studies conclude that the resection of the primary tumor before administering systemic chemotherapy in patients with CRC, unresectable metastases and good performance status improves the prognosis in these patients.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> At the same time, other groups argue that the benefits of initial primary tumor resection on survival have not been demonstrated; in addition, the morbidity and mortality of surgery should be avoided, especially since this could delay the start of chemotherapy and its potential benefits on survival.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,10–12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Different studies observe a longer mean survival in patients with resection of the primary tumor compared to those who are not resected.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9,13,14</span></a> These are retrospective, non-randomized studies, which could mean that the patients who were treated surgically presented a better performance status or had a lower tumor load. Greater toxicity to chemotherapy has also been observed in patients without resection when compared to a group of patients with resection of the primary tumor.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recently, the <span class="elsevierStyleItalic">Dutch Colorectal Cancer Group</span> published a study<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> that evaluated the prognostic value of primary tumor resection depending on the first line of treatment received according to the CAIRO and CAIRO2 studies.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> The results showed a mean survival of 13 months in the non-resection group versus 22–24 months in the resection group. Despite the difference observed, the patients were not randomized before the tumor resection, which could mean that the characteristics of the patients were not homogeneous. Our group has observed that the 2-year survival in patients with intestinal obstruction due to unresectable stage IV colorectal cancer who had tumor resection is greater than in the patients without tumor resection (39.3% versus 1%, respectively).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Other workgroups have tried to resolve this dilemma by formulating different questions. Such is the case of The National Surgical Adjuvant Breast and Bowel Project C-10 (NASBP C-10) group, which specifically asked if the addition of bevacizumab to FOLFOX increases the number of complications in patients with stage IV CRC without resection of the primary tumor.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The results showed that only 14% of patients presented major complications (obstruction, perforation, or hemorrhage), so the authors concluded that the incidence of severe complications was acceptable when the primary lesion was not resected. In addition, they emphasized that the survival was not compromised by leaving the primary tumor <span class="elsevierStyleItalic">in situ.</span></p><p id="par0035" class="elsevierStylePara elsevierViewall">More recently, the University College Hospital in London initiated a clinical trial with the main objective to determine whether overall survival in patients with stage IV asymptomatic CRC with unresectable metastasis is greater in patients treated with chemotherapy alone or with resection of the primary tumor plus chemotherapy, as described at ClinicalTrials.gov (register no. <a href="ctgov:NCT01086618">NCT01086618</a>).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Nonetheless, due to unknown reasons, it seems that the study has been suspended.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Whether due to the lack of homogeneity when comparing patient groups or to the limitations of the designs used to be able to provide evidence, the current dilemma persists and the debate continues.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Do patients with CRC and asymptomatic synchronous metastases benefit from the resection of primary tumors with regard to longer survival or better quality of life? Or, is there no benefit at all?</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considering the increased prevalence of colorectal cancer and the important percentage of patients who are diagnosed with stage IV tumors with unresectable metastases, the question could be answered by multi-center projects involving multidisciplinary groups with experience in the treatment of colorectal cancer. This is the only way to provide evidence regarding a controversial topic with high impact in our society.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-05-07" "fechaAceptado" => "2013-05-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Biondo S, Frago R. Valor de la resección tumoral en el cáncer colorrectal con metástasis irresecables. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 8 | 6 | 14 |
| 2024 September | 14 | 4 | 18 |
| 2024 August | 15 | 1 | 16 |
| 2024 July | 22 | 6 | 28 |
| 2024 June | 11 | 2 | 13 |
| 2024 May | 11 | 5 | 16 |
| 2024 April | 12 | 10 | 22 |
| 2024 March | 18 | 6 | 24 |
| 2024 February | 16 | 4 | 20 |
| 2024 January | 16 | 2 | 18 |
| 2023 December | 24 | 2 | 26 |
| 2023 November | 10 | 5 | 15 |
| 2023 October | 22 | 1 | 23 |
| 2023 September | 7 | 1 | 8 |
| 2023 August | 10 | 4 | 14 |
| 2023 July | 18 | 3 | 21 |
| 2023 June | 6 | 2 | 8 |
| 2023 May | 6 | 1 | 7 |
| 2023 April | 9 | 0 | 9 |
| 2023 March | 5 | 3 | 8 |
| 2023 February | 7 | 2 | 9 |
| 2023 January | 13 | 2 | 15 |
| 2022 December | 16 | 9 | 25 |
| 2022 November | 48 | 4 | 52 |
| 2022 October | 21 | 13 | 34 |
| 2022 September | 11 | 11 | 22 |
| 2022 August | 17 | 9 | 26 |
| 2022 July | 8 | 8 | 16 |
| 2022 June | 15 | 2 | 17 |
| 2022 May | 12 | 5 | 17 |
| 2022 April | 9 | 7 | 16 |
| 2022 March | 11 | 8 | 19 |
| 2022 February | 11 | 4 | 15 |
| 2022 January | 13 | 6 | 19 |
| 2021 December | 10 | 8 | 18 |
| 2021 November | 8 | 10 | 18 |
| 2021 October | 12 | 9 | 21 |
| 2021 September | 6 | 7 | 13 |
| 2021 August | 9 | 8 | 17 |
| 2021 July | 20 | 7 | 27 |
| 2021 June | 10 | 7 | 17 |
| 2021 May | 9 | 10 | 19 |
| 2021 April | 22 | 3 | 25 |
| 2021 March | 16 | 5 | 21 |
| 2021 February | 15 | 6 | 21 |
| 2021 January | 9 | 9 | 18 |
| 2020 December | 7 | 9 | 16 |
| 2020 November | 5 | 2 | 7 |
| 2020 October | 7 | 5 | 12 |
| 2020 September | 9 | 9 | 18 |
| 2020 August | 10 | 8 | 18 |
| 2020 July | 8 | 8 | 16 |
| 2020 June | 11 | 5 | 16 |
| 2020 May | 15 | 8 | 23 |
| 2020 April | 12 | 4 | 16 |
| 2020 March | 7 | 5 | 12 |
| 2020 February | 11 | 5 | 16 |
| 2020 January | 14 | 4 | 18 |
| 2019 December | 15 | 9 | 24 |
| 2019 November | 13 | 7 | 20 |
| 2019 October | 3 | 2 | 5 |
| 2019 September | 10 | 1 | 11 |
| 2019 August | 4 | 4 | 8 |
| 2019 July | 10 | 22 | 32 |
| 2019 June | 7 | 11 | 18 |
| 2019 May | 68 | 14 | 82 |
| 2019 April | 28 | 7 | 35 |
| 2019 March | 6 | 5 | 11 |
| 2019 February | 7 | 4 | 11 |
| 2019 January | 6 | 3 | 9 |
| 2018 December | 5 | 7 | 12 |
| 2018 November | 8 | 5 | 13 |
| 2018 October | 9 | 6 | 15 |
| 2018 September | 5 | 4 | 9 |
| 2018 August | 5 | 0 | 5 |
| 2018 July | 7 | 1 | 8 |
| 2018 June | 11 | 0 | 11 |
| 2018 May | 5 | 4 | 9 |
| 2018 April | 2 | 2 | 4 |
| 2018 March | 4 | 1 | 5 |
| 2018 February | 12 | 1 | 13 |
| 2018 January | 0 | 1 | 1 |
| 2017 December | 7 | 3 | 10 |
| 2017 November | 4 | 5 | 9 |
| 2017 October | 5 | 1 | 6 |
| 2017 September | 11 | 6 | 17 |
| 2017 August | 17 | 3 | 20 |
| 2017 July | 22 | 1 | 23 |
| 2017 June | 12 | 3 | 15 |
| 2017 May | 13 | 6 | 19 |
| 2017 April | 6 | 4 | 10 |
| 2017 March | 9 | 8 | 17 |
| 2017 February | 11 | 1 | 12 |
| 2017 January | 10 | 1 | 11 |
| 2016 December | 8 | 6 | 14 |
| 2016 November | 10 | 1 | 11 |
| 2016 October | 24 | 3 | 27 |
| 2016 September | 29 | 3 | 32 |
| 2016 August | 12 | 3 | 15 |
| 2016 July | 11 | 1 | 12 |
| 2016 June | 11 | 8 | 19 |
| 2016 May | 26 | 7 | 33 |
| 2016 April | 14 | 10 | 24 |
| 2016 March | 15 | 14 | 29 |
| 2016 February | 6 | 2 | 8 |
| 2016 January | 8 | 5 | 13 |
| 2015 December | 6 | 5 | 11 |
| 2015 November | 14 | 7 | 21 |
| 2015 October | 20 | 5 | 25 |
| 2015 September | 21 | 4 | 25 |
| 2015 August | 19 | 4 | 23 |
| 2015 July | 8 | 2 | 10 |
| 2015 June | 5 | 2 | 7 |
| 2015 May | 11 | 2 | 13 |
| 2015 April | 21 | 1 | 22 |
| 2015 March | 22 | 6 | 28 |
| 2015 February | 12 | 1 | 13 |
| 2015 January | 25 | 4 | 29 |
| 2014 December | 48 | 9 | 57 |
| 2014 November | 18 | 4 | 22 |
| 2014 October | 18 | 4 | 22 |
| 2014 September | 18 | 7 | 25 |
| 2014 August | 21 | 1 | 22 |
| 2014 July | 30 | 1 | 31 |
| 2014 June | 18 | 4 | 22 |
| 2014 May | 14 | 3 | 17 |
| 2014 April | 15 | 1 | 16 |
| 2014 March | 9 | 0 | 9 |
| 2014 February | 12 | 4 | 16 |
| 2014 January | 13 | 3 | 16 |
| 2013 December | 42 | 5 | 47 |
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