Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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Clinical Impact of Palliative Surgery in Unresectable Stage IV Colorectal Cancer

절제 불가능한 4기 대장암에서 고식적 수술의 임상적 효과

  • Yoonsuk Lee (Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • 이윤석 (가톨릭대학교 의과대학 서울성모병원 대장항문외과)
  • Received : 2016.12.04
  • Accepted : 2017.06.03
  • Published : 2017.06.30
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Abstract

In unresectable stage IV colorectal cancer, the role of palliative surgery is not defined clearly. The palliative surgery can be categorized into two surgeries; first, palliative primary tumor resection; second, palliative metastatectomy. Several retrospective studies reported initial palliative systemic chemotherapy in unresectable stage IV colorectal cancer did not increase primary tumor related complications such as obstruction, perforation and hemorrhage, so they insisted that primary tumor resection in asymptomatic stage IV colorectal cancer should be preserved. However, in terms of overall survival and cancer-specific or progression-free survival, several retrospective studies, especially using population-based big data, reported favored survivals in palliative primary tumor resection group. And also several studies reported that palliative metastatectomy such as liver resection without resection of lung metastasis showed better overall survivals. But those results from those studies came from retrospective studies and are likely to be affected by selection bias. Prospective randomized studies are needed to define the benefit of palliative primary tumor resection and metastatectomy in unresectable stage IV colorectal cancer. However, based on the updated evidences, the dogma that palliative primary tumor resection should be preserved in asymptomatic unresectable stage IV colorectal cancer should be questioned.

Keywords

References

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