531P - Should palliative resection of primary tumor be performed in patients with advanced colorectal cancer? A systematic review & meta-analysis

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Colon and Rectal Cancer
Surgical oncology
Radiation oncology
Presenter Shahid Ahmed
Authors S. Ahmed1, R.K. Shahid2, A. Leis3, K. Haider1, P. Pahwa3
  • 1Medical Oncology, Saskatoon Cancer Centre University of Saskatchewan, S7N 4H4 - Saskatoon/CA
  • 2Medicine, University of Saskatchewan, S7N 4H4 - Saskatoon/CA
  • 3Community Health & Epidemiology, University of Saskatchewan, S7N 4H4 - Saskatoon/CA



Colorectal cancer (CRC) is a leading cause of cancer death. Surgical resection of the primary tumor in patients with advanced CRC remains controversial. Limited data is available regarding potential benefits and risk of primary tumor resection in such patients.


To compare survival of patients with advanced CRC who underwent surgical resection of primary tumor with patients without resection. The review also aims to determine post-operative mortality & non-fatal complications rates, primary tumor complications rate (PTCR), non-resection surgical procedures rate (NSPR) and quality of life (QOL).


A literature search was conducted by using CENTRAL (2012), Medline (1946-2012), and EMBASE (1947-2012). Selection Criteria: Studies involving patients with advanced colorectal adenocarcinoma who underwent primary tumor resection were selected using pre-specified eligibility criteria with restriction to publication dates from 1980, English language and human studies. Data Collection and analysis: Screening, evaluation of relevant articles and data abstraction was done in duplication and agreement was assessed. Articles that met the inclusion criteria were assessed for quality by using Ottawa-Newcastle score. Data was collected and synthesized as per protocol.


Of total of 3379 reports, 15 retrospective observational studies were selected with patients population of 12456. Among 12456 patients, 8620 (69%) underwent surgery with a median overall survival of the 15.2 months (range: 10-30.7) compared with 11.4 months (range: 3-22) of the non-resection group. Hazard ratio (HR) for survival was 1.44 (95% CI: 1.26-1.64) favoring surgical intervention. Mean 30 days post-operative mortality and non-fatal complications rates were 4.9% (95% CI: 0-9.7) & 25.9% (95%CI: 20.1-31.6) respectively. Mean PTCR & NSPR in the control group were 29.7% (95%CI: 18.5-41.0) and 27.6% (95 CI: 15.4-39.9) respectively. No study provided QOL data. Sub-group analysis that were defined a priori revealed HR of 1.46 (95% CI: 1.20-1.78) favoring surgical intervention in patients treated with modern chemotherapy.


The retrospective data favors primary tumors resection in advanced CRC. Future prospective randomized trials are warranted to confirm the findings.


All authors have declared no conflicts of interest.