Daniel den Hoed Cancer Center, Department of Surgical Oncology, Erasmus MC, Rotterdam, The Netherlands.
Eur J Cancer. 2011 Sep;47 Suppl 3:S61-6. doi: 10.1016/S0959-8049(11)70148-4.
Surgery plays an important role in the treatment of patients with limited metastatic disease of colorectal cancer (CRC). Long term survival and cure is reported in 20-50% of highly selected patients with oligometastatic disease who underwent surgery. This paper describes the role of surgery of the primary tumour in patients with unresectable stage IV colorectal cancer. Owing to the increased efficacy of chemotherapeutic regimens in stage IV colorectal cancer, complications from unresected primary tumours are relatively infrequent. The risk of emergency surgical intervention is less than 15% in patients with synchronous metastatic disease who are treated with chemotherapy. Therefore, there is a tendency among surgeons not to resect the primary tumour in case of unresectable metastases. However, it is suggested that resection of the primary tumour in case of unresectable metastatic disease might influence overall survival. All studies described in the literature (n = 24) are non-randomised and the majority is single-centre and retrospective of nature. Most studies are in favour of resection of the primary tumour in patients with symptomatic lesions. In asymptomatic patients the results are less clear, although median overall survival seems to be improved in resected patients in the majority of studies. The major drawback of all these studies is that primarily patients with a better performance status and better prognosis (less metastatic sites involved) are being operated on. Another limitation of these studies is that few if any data on the use of systemic therapy are presented, which makes it difficult to assess the relative contribution of resection on outcome. Prospective studies on this topic are warranted, and are currently being planned.
Surgery of the primary tumour in patients with synchronous metastasised CRC is controversial, although data from the literature suggest that resection might be a positive prognostic factor for survival. Therefore prospective studies on the value of resection in this setting are required.
手术在治疗结直肠癌（CRC）转移性疾病患者中起着重要作用。在接受手术的寡转移性疾病高度选择患者中，有 20-50%的患者报告长期生存和治愈。本文描述了不可切除的 IV 期结直肠癌患者原发肿瘤手术的作用。由于 IV 期结直肠癌化疗方案疗效的提高，未切除原发肿瘤的并发症相对较少。在接受化疗的同步转移性疾病患者中，紧急手术干预的风险小于 15%。因此，外科医生倾向于不切除不可切除转移灶的原发肿瘤。然而，有研究表明，在不可切除的转移性疾病情况下切除原发肿瘤可能会影响总体生存。文献中描述的所有研究（n=24）均为非随机研究，且大多数为单中心和回顾性研究。大多数研究支持对有症状病变的患者切除原发肿瘤。在无症状患者中，结果不太明确，尽管在大多数研究中，切除患者的中位总生存期似乎有所改善。所有这些研究的主要缺点是，主要是那些体能状态较好、预后较好（转移灶较少）的患者接受了手术。这些研究的另一个局限性是，很少或没有提供关于系统治疗使用的数据，这使得难以评估切除对结果的相对贡献。需要对此主题进行前瞻性研究，目前正在计划中。
同步转移的 CRC 患者的原发肿瘤手术存在争议，尽管来自文献的数据表明切除可能是生存的一个积极预后因素。因此，需要在这种情况下对切除的价值进行前瞻性研究。
