Surgery Down, Survival Up for Colorectal Cancer

Advanced colon cancer patients saw a decrease in primary tumor resection surgery rates and a spike in survival

(RxWiki News) As the surgery rate for stage IV colorectal cancer patients has dropped and the rates of other treatments have risen, the survival rate for these patients has spiked.

A new study found that, despite a decrease in the rate of a surgical procedure called primary tumor resection (PTR), the survival rate for people with advanced colorectal cancer more than doubled.

Improved survival rates could be the result of better therapies, the authors of this study noted. However, they cautioned that PTR may still be overused.

“Despite the proven benefit of chemotherapy, more than half of the patients in our cohort with [advanced colorectal cancer] had undergone PTR in 2010," wrote the authors of this study, led by Chung-Yuan Hu, PhD, of the University of Texas MD Anderson Cancer Center in Houston.

PTR is a surgical procedure in which the cancer/tumor is removed, along with some of the surrounding healthy tissue.

Before cancer treatments like chemotherapy and radiation became available, PTR was the only means of treatment. Like all surgeries, however, PTR can have complications like bleeding or infection — and there is always a risk with anesthesia as well.

Stage IV colorectal cancer (CRC) is an advanced form of cancer, and about 20 percent of patients are diagnosed at stage IV, Dr. Hu and team noted. The five-year survival rate for these patients is about 12.5 percent.

These researchers studied more than 64,000 patients diagnosed with stage IV CRC, some of whom had undergone PTR. Dr. Hu and team found that 67.4 percent of the patients had undergone PTR.

However, the annual rate for PTR dropped more than 17 percent from 1988 to 2010. This drop was most noticeable after 2001, when the US Food and Drug Administration approved a number of new chemotherapy medications.

In 1988, the survival rate for stage IV CRC was 8.6 percent. By 2009, survival rates had climbed to 17.8 percent, Dr. Hu and colleagues found.

The decision to have surgery is made jointly by the patient and doctor, and each case is different. Nevertheless, Dr. Hu and team expressed concerns that PTR may still be overused. They noted that the current recommendation for stage IV CRC is chemotherapy and other treatments rather than surgery. Chemotherapy is a cancer treatment in which patients take medications to kill cancer cells in their bodies.

This study was published Jan. 14 in JAMA Surgery.

Drs. Christina E. Bailey and George J. Chang received grants from the National Institutes of Health/National Cancer Institute. Dr. Chang also received the American Society of Clinical Oncology Foundation's Career Development Award. The authors disclosed no conflicts of interest.

Review Date: 
January 13, 2015