Researchers found in a new study that treatment of primary
and secondary tumors in colon cancer patients must be highly
individualized. They developed a list of assessments for doctors to
consider when creating treatment plans for patients. About 20 percent of patients' cancer has spread by the time
they are diagnosed, and secondary tumors are most often found in the
liver. The option is whether to perform both surgeries at once, or do
them one at a time.
"Our primary aim was to establish the magnitude of risk that
each component operation, both liver and colon, contributed to
synchronous resections in order to determine which combination of colon
and liver operations were most safe to be performed at the same time,"
Dr. David Nagorney stated.
Researchers identified 43,408 patients who underwent
colorectal and liver resections for stage IV colon cancer using data
from the National Surgical Quality Improvement Program.
Risk categories were assigned for each of the operations
based on difficulty, seriousness and number of secondary tumors, and
individual patient potentials, comparing them to 30-day post-surgical
outcomes. Within these groups, the researchers also compared patients
who'd had surgery in each risk category depending on whether colorectal
and liver surgeries were done at the same time or sequentially.
The researchers found that, overall, syncronous surgery to
remove primary colorectal tumors and secondary liver tumors is safe and
effective in patients who need only minor liver resection to remove
cancer. However, the potential for poor outcomes increases with the
level of high-risk surgery for either primary or secondary tumors, the
type of either surgery, and the number or size of secondary tumors. "Our findings also show that performing pre-operative risk
assessments on patients who require both liver and colorectal resections
could allow surgeons to more accurately predict patient outcomes and
assist in pre-operative planning and counseling these patients,"
Nagorney said.
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