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Surgery
not necessary for most Late-Stage Colorectal
Cancers
Newswise — A new study shows that a large
majority of patients who present with
advanced colorectal cancer that has spread
to other organs (stage IV) don’t require
immediate surgery to remove the primary
tumor in the colon.
Researchers from Memorial Sloan-Kettering
Cancer Center (MSKCC) presented their data
at the American Society of Clinical
Oncology Annual Meeting.
“For this population with metastatic disease
that cannot be cured by surgery, undergoing
colon surgery is not always necessary,” said
Philip Paty, a surgical oncologist at MSKCC
and one of the study’s lead authors.
“If the colon tumor is not causing
obstruction, perforation, or bleeding we’ve
found these patients are best treated with
chemotherapy.
"
By moving straight to chemotherapy, patients
can avoid the risk of surgical complications
and can start treatment for all sites of
disease without delay.”
For this retrospective study, a
multidisciplinary team looked at 233
metastatic colorectal cancer cases treated
at MSKCC from 2000 to 2006.
Their analysis showed that 217 of the 233
patients, or 93 percent, did not have
complications that required resection of the
primary tumor.
Only 16 patients required colon surgery for
symptom management.
Previously, in the conventional approach to
treating stage IV disease, patients
underwent colon surgery immediately
following their diagnosis and would
typically start chemotherapy treatments
three to six weeks later.
The rationale for immediate colon resection
was to prevent future symptoms and
complications from the primary tumor.
It was assumed that the majority of
colorectal cancers would have little
response to chemotherapy.
But with the development of better
chemotherapy treatments in the past decade,
doctors at MSKCC and others within the
oncology community started looking at
patients with stage IV disease differently,
and began to administer chemotherapy as
initial treatment.
Such treatments seemed to be reliable in
shrinking both colon tumors and the
metastases; however, there was not published
data to support this approach.
“We now know that the routine use of surgery
for these patients is based on old thinking,
and we’re beyond that.
"There
will always be the need for individual
exceptions based on the clinical situation,
but our default position should be not to
operate,” said Dr. Paty.
Colorectal cancer is the fourth most common
type of cancer and the second leading cause
of cancer-related death in the United
States.
Memorial Sloan-Kettering Cancer Center is
the world’s oldest and largest private
institution devoted to prevention, patient
care, research, and education in cancer.
Our scientists and clinicians generate
innovative approaches to better understand,
diagnose, and treat cancer. Our specialists
are leaders in biomedical research and in
translating the latest research to advance
the standard of cancer care worldwide. For
more information, go to
www.mskcc.org.
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