O-0014 - Palliative resection of the primary tumour is associated with increased survival in patients with synchronous metastatic colorectal cancer: a nation...

Date 27 June 2014
Event World GI 2014
Session Presentation of selected abstracts
Topics Colon Cancer
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Jorine 't Lam - Boer
Citation Annals of Oncology (2014) 25 (suppl_2): ii105-ii117. 10.1093/annonc/mdu193
Authors L. Van derGeest1, M. Elferink2
  • 1Comprehensive Cancer Center the Netherlands, Leiden/NL
  • 2Comprehensive Cancer Centre the Netherlands, Utrecht/NL



The benefit of resection of the primary tumour prior to the start of chemotherapy in patients with stage IV colorectal cancer (CRC) is still uncertain. Results of retrospective studies are suggestive of a survival benefit of several months. However, surgery can cause severe morbidity and mortality in these patients. We performed a population-based study to determine the benefit of palliative resection in patients with synchronous metastatic colorectal cancer.


All patients who presented between 2008 and 2011 with stage IV CRC were selected from a nationwide database (n = 10,593). Patients were divided into three categories according to applied therapy: curative treatment, palliative treatment and best supportive care. The palliative treatment group was further categorized by the first receive treatment, either systemic therapy or resection of the primary. Kaplan-Meier analysis and log-rank testing were used to estimate overall survival (OS). Multivariate logistic regression analysis was used to calculate association of resection of the primary tumour with patient and tumour characteristics. Cox regression analysis was used to calculate hazard ratios for survival.


Of the 10,593 patients, 2,360 patients (22.2%) were excluded, because of missing data or because patients did not meet inclusion criteria for one of the four categories. Of the remaining 8,233 patients, 18.3% (n = 1,510) underwent local treatment for metastases (curative treatment, median OS: 43.7 months) and 28.0% (n = 2,304) were not treated with life-prolonging therapy at all (best supportive care, median OS: 2.1 months). In the palliative treatment group, 1,908 patients initially underwent resection of the primary tumour, followed by systemic therapy in 949 patients (49.7%). The other 2,511 patients were initially treated with systemic therapy, followed by resection of the primary in 145 patients (5.8%). Median OS in the resection group was significantly higher compared to the systemic therapy group (median OS: 16.6 months versus 11.9 months). Resection of the primary tumour was more often performed in patients younger than 75 years, colon cancer patients and patients with one metastatic site. Cox regression analysis showed that resection was independently associated with increased OS (HR 0.38 [95%CI 0.34-0.43]).


This large population-based study shows an overall survival benefit for patients with stage IV CRC patients undergoing resection of the primary tumour, prior to systemic therapy, compared to systemic therapy alone. This survival benefit was found independently of other previously identified prognostic factors, such as age, location of the primary tumour, N-stage and extensiveness of metastatic disease.