Limited Surgery Better in Colon Cancer With Diffuse Liver Mets

ORLANDO—Researchers 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 procedures—such 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. Mitic said.