Evaluating surgery and chemotherapy versus chemotherapy alone for the treatment of metastatic colorectal cancer.

This study evaluated whether surgery of colorectal cancer (CRC) followed by chemotherapy (CT) improved the outcomes of patients with metastatic (spread) CRC compared to CT alone. The study found that there was no difference in patients' outcomes whether surgery was given or not.

CRC is the third most common cancer worldwide. Some patients do not report symptoms with the initial tumor. These patients are often only diagnosed when the cancer has spread to other areas (metastatic CRC). Metastatic CRC (mCRC) is hard to treat and often the tumor cannot be removed with surgery. Treatment for mCRC often includes CT. 

However, in some patients with mCRC, the initial tumor in the colon/rectum can be removed by surgery before CT. It is not clear if removing the initial tumor improves these patients’ response to treatment.

This study included 165 patients with mCRC. 81 patients were given surgery followed by CT. 84 patients received CT alone. The average follow-up time was 22 months.

Patients who had surgery and CT had an average survival of 25.9 months. Patients treated with CT alone had an average survival time of 26.7 months at the half-way point of the study. There was no significant difference in patient response between the groups. 87% of patients who received surgery + CT experienced disease progression. 93% of those treated with CT alone had disease progression.

More patients in the surgery + CT group reported side effects (87%) compared to 77% in the CT alone group.

The study found that chemotherapy alone resulted in similar outcomes as surgery followed by CT in patients with mCRC.

This study was completed early because there did not appear to be any difference between groups. The sample size was small. Also, the study did not report on patients’ quality of life related to therapy.