Superior Treatments Cause Drop in Advanced Colon Cancer Surgery

Annual rate of primary tumor removal has decreased since 1988.

Nonsurgical management of advanced colon cancer has contributed to a significant drop in surgery for the disease, according to a recent study.

In a report published online earlier this month in JAMA Surgery, researchers found that the rate of primary tumor removal for advanced stage IV colorectal cancer (CRC) has dropped annually since 1988. A trend beginning in 2001 toward management of the disease without surgery was found to correlate with newer chemotherapy and biologic treatments hitting the market.

Approximately 20% of patients diagnosed with stage IV CRC reported a 5-year relative survival rate of 12.5%, the study noted.

The researchers evaluated US patterns of primary tumor resection (PTR) and survival rates in stage IV CRC with data from the National Cancer Institute's Surveillance, Epidemiology and End Results CRC registry.

The study included 64,157 patients diagnosed with stage IV colon or rectal cancer from 1988 to 2010. Of those patients, 67.4% (43,273 of 64,157) underwent PTR.

The annual rate of PTR dropped from 74.5% in 1988 to 57.4% in 2010. The largest significant annual decreases occurred from 1998 to 2001 and from 2001 to 2010. Patients who received PTR trended towards being younger than 50 years of age, female, married, and having a higher tumor grade.

The median survival rate for stage IV CRC rose from 8.6% in 1988 to 17.8% in 2009.

Noted limitations of the study, included a declining rate of PTR that may have primarily been a result of more effective systemic therapy or due to greater reluctance by surgeons to operate on patients with asymptomatic stage IV CRC.

"Despite the availability of more effective chemotherapeutic options, a considerable number of patients with stage IV CRC continue to undergo PTR,” the study authors concluded. “Our findings indicate potential overuse of PTR among these patients and highlight a need to better understand the clinical decisions and outcomes associated with that treatment."