Asymptomatic colorectal cancer with un-resectable liver metastases: Immediate colorectal resection or up-front systemic chemotherapy?

Andrea Muratore, Daria Zorzi, Hedayat Bouzari, Marco Amisano, Paolo Massucco, Elisa Sperti, Lorenzo Capussotti

Research output: Contribution to journalArticle

Abstract

Background: About 20% of patients with colorectal cancer have synchronous un-resectable liver metastases. Resection of colorectal cancer in patients with moderate-severe symptoms is mandatory before starting chemotherapy. Surgical treatment of asymptomatic colorectal cancers is still a matter of discussion. Methods: From January 2000 to December 2004, we prospectively collected data on 35 consecutive patients who were treated straightaway by chemotherapy without primary tumor resection. All patients underwent FOLFOX6 as first-line chemotherapy. The aim of the study was to evaluate the rate of surgical complications related to un-resected colorectal tumor. Results: The mean interval between diagnosis and start of chemotherapy was 23.1 days (95% CI: 17.3-28.8). Fifteen of the 35 patients (42.9%) were down-staged to surgery; the mean interval between chemotherapy start and colon-rectum cancer resection was 6.5 months (95% CI: 5.5-7.5). None of them developed complications related to the primary tumor during chemotherapy. Of the other 20 patients who did not undergo any curative surgery, 16 received a second line chemotherapy and 10 a third line: six patients are alive and without intestinal symptoms (mean follow up 22.5 months, 95% CI: 11.2-33.9). Only one patient (2.8%) developed clinical signs of intestinal occlusion 5.6 months from the start of chemotherapy and required urgent colostomy. Conclusions: The rate of complications related to the non-resected colorectal tumor is very low using oxaliplatin as first line chemotherapy. Non-operative management of asymptomatic colorectal cancers with un-resectable liver metastases is a safe approach.

Original languageEnglish
Pages (from-to)766-770
Number of pages5
JournalAnnals of Surgical Oncology
Volume14
Issue number2
DOIs
Publication statusPublished - Feb 2007

Keywords

  • Chemotherapy
  • Colorectal cancer
  • Liver metastases
  • Surgical management

ASJC Scopus subject areas

  • Surgery
  • Oncology

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