ORLANDOResearchers in Germany have found that in cases of
advanced colorectal cancer that has metastasized to and destroyed
more than 30% of the liver, surgical removal of the colorectal tumor
does not benefit the patient. On the contrary, said Sandra Mitic, MD,
these seriously ill patients, who are soon to die anyway, are
better off if surgeons perform the most limited procedure
possible. Dr. Mitic described the study in a poster
presentation at the Digestive Disease Week meeting.
The researchers enrolled 33 patients from June 1996 to June 1998.
Thirty had tumors in the left hemicolon and rectum, and all had lymph
node metastases. The researchers excluded any patients who had
undergone radiation therapy or chemotherapy.
Among patients who presented with more than 30% destruction of the
hepatic parenchyma and who underwent resection, 44% experienced
complications and 22.2% died. The risks of complications and death
were avoided in comparable patients who did not undergo surgery.
In looking at patients quality of life (QOL) after surgery,
they found that all patients whose hepatic destruction was less than
30% were successfully discharged from the hospital. In the group
whose hepatic destruction exceeded 50%, 5 of 15 patients treated with
colostomy and only 1 of 15 patients who received a segmental colonic
resection were able to leave the hospital.
Patients More Likely to Go Home
These patients do not profit from major surgery, Dr.
Mitic said. They are better off if they are treated with
smaller proceduressuch as a colostomy or bypass operation that
allows passage. Then they stand a better chance of going home to be
with their families for a time before they die.
The researchers did allow some exceptions to this general rule.
If the tumor can be reached easily or if the patient wants to
avoid colostomy, then limited resective procedures should be used.
The next research direction being taken by this German group is to
see if chemotherapy of the colon and liver will prolong life, Dr.