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1 surgery better than 2 for some
colorectal cancer patients
WASHINGTON, D.C. -- A single surgery to remove cancer from both the
colon and the liver to which it has spread may be better in some
cases than the current standard treatment of two separate surgeries
with chemotherapy in between, according to a study led by Duke
University Medical Center researchers.
Simultaneous surgeries on the colon and liver may reduce the length
of a patient’s stay in the hospital and potentially lessen the risk
of surgical complications without compromising long-term survival,
according to the study.
"In about a third of patients who are newly
diagnosed with colorectal cancer, the cancer has
already spread to the liver," said Bryan Clary,
M.D., a surgical oncologist at Duke and senior
investigator on the study.
"The
standard approach for these patients has been to remove the
colorectal cancer and give them chemotherapy afterwards, waiting to
remove liver tumors later if patients do not appear to be developing
disease elsewhere in the body. These findings suggest there might be
an alternative that is as safe and may even lead to better
outcomes."
Colorectal
cancer is the third most common cancer in both men and women in the
United States, and it is the second-leading cause of cancer-related
deaths in this country.
The
researchers presented their findings on Saturday, March 17, in a
plenary session at the annual meeting of the Society of Surgical
Oncology in Washington, D.C. The study was funded by the National
Institutes of Health and Duke’s Department of Surgery.
The
researchers looked at outcomes for 610 patients who had undergone
either simultaneous or separate surgeries for removal of colorectal
cancer from the colon or rectum and from the liver, where it had
spread. The patients were treated at three academic medical centers
-- Duke, the Sidney Kimmel Comprehensive Cancer Center at Johns
Hopkins University and the University of Texas M.D. Anderson Cancer
Center -- between 1985 and 2006.
"We looked
at factors including surgical complications and survival data among
the groups and found that in certain patient groups, simultaneous
surgery was as safe as separate surgeries, could shorten the length
of hospital stay and might lead to fewer surgery-related
complications," said Srinevas Reddy, M.D., a general surgery
resident at Duke and the study’s lead author.
Chemotherapy is used in addition to cancer surgery to kill cancer
cells that may reside undetected in other parts of the body.
Patients having separate surgeries commonly receive chemotherapy
both after their initial colon surgery and then again after their
liver surgery, Clary said. But the powerful drugs used in
chemotherapy can have a toxic effect on other organs, including the
liver, that may increase the risk of liver surgery, he said.
The
researchers also discovered that chemotherapy administered after
surgical removal of cancerous liver segments favorably affected
survival rates, whether or not that surgery was done alone or in
conjunction with colorectal surgery. Chemotherapy administered
before liver surgery showed no benefits, Clary said.
The
researchers found that simultaneous surgery was only as safe as
standard treatment among patients who required a minimal amount of
liver to be removed. But for those whose cancer was more extensive
requiring larger amounts of liver to be removed, separate surgeries
remain the better treatment choice.
"For
patients who require a great deal of liver to be removed, the
complication risks associated with such extensive surgery outweigh
the benefits of doing it all at once," Clary said.
About half
of patients with colorectal and liver tumors could be eligible for
the simultaneous surgery, which could translate to about 25,000
patients per year, he said.
"This
study is important because it shows that patients with liver
metastases at the time of their original colorectal cancer diagnosis
might benefit from evaluation at a multidisciplinary center that
includes not only medical oncologists and surgical oncologists
skilled in colorectal surgery, but also surgeons capable of
performing liver surgery," Clary said. |
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