Palliative primary tumor resection in minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases: when is it necessary? (systematic review)

Abstract

AIM: to determine if there is an improvement in overall survival of palliative primary tumor resection (PTR) followed by chemotherapy in minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases compared to those of upfront chemotherapy/radiotherapy (chemo/RT) alone.MATERIALS AND METHODS: a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were done on PubMed and Cochrane database.RESULTS: eighteen non-randomized studies were identified, including a total of 2995 patients (1734 PTR and 1261 chemo/RT). Age, gender, American Society of Anesthesiologists (ASA) staging of patients in the two groups were comparable in 12 studies and had significant differences in 4 studies. Median survival in the two groups was comparable in 13 studies (1460 patients: 787 PTR и 673 chemo/RT) and was significantly higher in PTR group in 5 studies (1535 patients: 947 PTR и588 chemo/RT). The rate of surgical intervention due to complications was 0-5.1% in PTR group and 4.4-48.1% in chemo/RT group in 17 studies. Thirty-day mortality was 0-4.8% in PTR group and 0-14% in chemo/RT group in 17 studies. One study had a high 30-day mortality rate in both groups (29.4% PTR и 19.3% chemo/RT, P < 0.05).CONCLUSIONS: the question remains whether palliative primary tumor resection could improve overall survival of minimally symptomatic patients with colorectal cancer and synchronous unresectable metastases. However, the recent data showed that patients who underwent PTR could gain a cancer-specific survival benefit. This conclusion based on the results of nonrandomized comparative studies and data from early terminated RCTs. Further well-designed RCTs are required to reach definitive conclusions.