The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis

Zongyu Liang; Zhiyuan Liu; Chengzhi Huang; Xin Chen; Zhaojun Zhang; Meijuan Xiang; Weixian Hu; Junjiang Wang; Xingyu Feng; Xueqing Yao

doi:10.3389/fsurg.2022.1047373

The role of upfront primary tumor resection in asymptomatic patients with unresectable stage IV colorectal cancer: A systematic review and meta-analysis

Front Surg. 2023 Jan 6:9:1047373. doi: 10.3389/fsurg.2022.1047373. eCollection 2022.

Authors

Zongyu Liang^{1

2

3

4}, Zhiyuan Liu^{2

3

4}, Chengzhi Huang^{2

4

5}, Xin Chen^{2

3

4}, Zhaojun Zhang^{2

4

6}, Meijuan Xiang^{2

4

6}, Weixian Hu², Junjiang Wang^{2

3

5

7}, Xingyu Feng², Xueqing Yao^{2

3

4

5

6

7}

Affiliations

¹ Department of Gastrointestinal Surgery, Second Department of General Surgery, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China.
² Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Shantou University Medical College, Shantou, China.
⁴ Guangdong Provincial People's Hospital Ganzhou Hospital (Ganzhou Municipal Hospital), Ganzhou, China.
⁵ School of Medicine, South China University of Technology, Guangzhou, China.
⁶ School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.
⁷ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.

Abstract

Background: Controversy exists over the role of upfront primary tumor resection (PTR) in asymptomatic patients with unresectable stage IV colorectal cancer (CRC). The purpose of this study was to evaluate the effect of upfront PTR on survival outcomes and adverse outcomes.

Methods: Searches were conducted on PubMed, EMBASE, Web of Science, and Cochrane Library from inception to August 2021. Studies comparing survival outcomes with or without adverse outcomes between PTR and non-PTR treatments were included. Review Manager 5.3 was applied for meta-analyses with a random-effects model whenever possible.

Results: Overall, 20 studies with 3,088 patients were finally included in this systematic review. Compared with non-PTR, upfront PTR was associated with better 3-year (HR: 0.69, 95% CI, 0.57-0.83, P = 0.0001) and 5-year overall survival (OS) (HR: 0.77, 95% CI, 0.62-0.95, P = 0.01), while subgroup analysis indicated that there was no significant difference between upfront PTR and upfront chemotherapy (CT) group. In addition, grade 3 or higher adverse effects due to CT were more frequent in the PTR group with marginal significance (OR: 1.74, 95% CI, 0.99-3.06, P = 0.05), and other adverse outcomes were comparable.

Conclusions: PTR might be related to improved OS for asymptomatic patients with unresectable stage IV CRC, whereas receiving upfront CT is a rational alternative without detrimental influence on survival or adverse outcomes compared with upfront PTR.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272675.

Keywords: asymptomatic; colorectal cancer; overall survival; primary tumor resection; unresectable.

Publication types

Review

Grants and funding

This work was supported by grants from the Science and Technology Planning Project of Guangdong Province, China (2017A030223006, 2016A020215128), the Science and Technology Planning Project of Guangzhou, China (201704020077), the Second Batch of Scientific Research Projects of Dengfeng Plan (DFJH201913), the Research Fund of CSCO-Roche Oncology (Y-2019Roche-190), the Research Fund of CSCO-Hansoh Oncology (Y-HS2019/2-050), the Research Fund of Guangdong General Hospital (No. y012015338), the Yuexiu Science and Information Center of Guangzhou Scientific Foundation (2012-GX-046), the Medical Scientific Research Foundation of Guangdong Province, China (A2020019), and the Science and Technology Plan of Guangzhou, Guangdong Province, China (202102080230).