An Increasing Role for Cytoreductive Surgery in Metastatic Colorectal Cancer-National Trends in the Era of More Effective Systemic Therapy.

BACKGROUND AND

OBJECTIVES

Treatment guidelines on cytoreductive surgery (CRS) for metastatic colorectal cancer (mCRC) continue to have variability. This study investigated survival outcomes and utilization trends of CRS on mCRC.

METHODS

Patients from the National Cancer Database with mCRC who received systemic chemotherapy 2004-2015 were categorized by colectomy, colectomy and metastasectomy (CRS), and no surgery (NS). Kaplan-Meier analyses with inverse probability of treatment weighting (IPTW) were performed.

RESULTS

Of 88 593 patients in the study cohort, 39 028 had a colectomy, 21 462 CRS, and 28 103 NS. CRS utilization increased from 33.1% (2004) to 38.3% (2015). CRS (aHR = 0.36) and colectomy (aHR = 0.47) were associated with significantly improved OS compared to NS. Median OS with IPTW remained longer in CRS versus colectomy versus NS (34.4 months vs. 26.7 vs. 13.2) (p < 0.001). Patients who received hyperthermic intraperitoneal chemotherapy (HIPEC) had improved OS compared to non-HIPEC patients (aHR = 0.55, p < 0.001).

CONCLUSIONS

National utilization of CRS for mCRC is steadily increasing and associated with improved OS, supporting the use of more aggressive surgical approaches in select patients.