The impact of primary tumor resection on overall survival in patients with colorectal carcinoma and unresectable distant metastases: A prospective cohort study

• Has primary tumor resection any survival benefit in patients with non-resectable and metastatic colorectal carcinoma?
• So far, conflicting conclusions have been reached in various clinical trials.
• Some studies indicating survival benefit associated with resection of primary tumor, while others finding no benefit.
• Our study cohort (the number of cases in our study) is larger than some clinical trials.
• We believe that our study will contribute to the clarification of this controversial issue.

BackgroundTo compare the patients with primary colorectal carcinoma (CRC) and non-resectable distant metastases with or without primary colorectal tumor resection as a primary treatment in terms of postoperative mortality and overall survival (OS).Patients and methodsThe clinicopathological data of 188 CRC patients with non-resectable distant metastases was analyzed. All patient data were collected prospectively. Colorectal tumor was resected in 121 patients (64.3%). Kaplan–Meier method was used for calculation and plotting of the OS curves of the patient groups, and log-rank test was used for the comparison of the survival curves. The relative importance of the prognostic features was investigated using the Cox proportional hazards model.ResultsIn the whole series and in the patient group undergoing emergency surgical intervention, mortality rate was lower in patients having colorectal tumor resection compared with non-resected patients, with differences approaching the significance level (p = 0.072 and p = 0.076, respectively). Median OS time was significantly longer in resection group (11.0 months), compared with non-resection group (5.5 months) (p < 0.001); in the multivariate Cox analysis colorectal tumor resection had independent prognostic significance (p < 0.001).ConclusionResection of colorectal tumor in primary CRC patients with non-resectable distant metastasis gives significant survival advantage without increasing postoperative mortality compared with non-resection.