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Asymptomatic Colorectal Cancer with Un-Resectable Liver Metastases: Immediate Colorectal Resection or Up-Front Systemic Chemotherapy?

¹ Division of Surgical Oncology, Istituto per la Ricerca e la Cura del Cancro, Candiolo (TO), Italy
² Division of Medical Oncology, Istituto per la Ricerca e la Cura del Cancro, Candiolo (TO), Italy

Correspondence: Address correspondence and reprint requests to: Andrea Muratore, MD, Via Muratori 2C, 10126, Torino, Italy; E-mail: andrea.muratore{at}ircc.it

Background: About 20% of patients with colorectal cancer have synchronous unresectable liver metastases. Resection of colorectal cancer in patients with moderate-severe symptoms is mandatory before starting chemotherapy. Surgical treatment of asymptomatic colorectal cancers is still a matter of discussion.

Methods: From January 2000 to December 2004, we prospectively collected data on 35 consecutive patients who were treated straightaway by chemotherapy without primary tumor resection. All patients underwent FOLFOX6 as first-line chemotherapy. The aim of the study was to evaluate the rate of surgical complications related to unresected colorectal tumor.

Results: The mean interval between diagnosis and start of chemotherapy was 23.1 days (95% CI: 17.3–28.8). Fifteen of the 35 patients (42.9% ) were down-staged to surgery; the mean interval between chemotherapy start and colon-rectum cancer resection was 6.5 months (95% CI: 5.5–7.5). None of them developed complications related to the primary tumor during chemotherapy. Of the other 20 patients who did not undergo any curative surgery, 16 received a second line chemotherapy and 10 a third line: six patients are alive and without intestinal symptoms (mean follow up 22.5 months, 95% CI: 11.2–33.9). Only one patient (2.8% ) developed clinical signs of intestinal occlusion 5.6 months from the start of chemotherapy and required urgent colostomy.

Conclusions: The rate of complications related to the non-resected colorectal tumor is very low using oxaliplatin as first line chemotherapy. Non-operative management of asymptomatic colorectal cancers with un-resectable liver metastases is a safe approach.

Key Words: Colorectal cancer • Liver metastases • Surgical management • Chemotherapy

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