Second surgery or chemotherapy for relapse after radical resection of colorectal cancer metastases.
OBJECTIVE
Limited data suggest that second resections for colorectal cancer metastases may improve survival, but no study has compared surgery with chemotherapy in this setting. Therefore, we retrospectively compared the clinical outcome of potentially resectable patients who received a second metastasectomy with those who did not in our single-centre experience.


METHODS
We retrospectively reviewed the clinical records of all patients treated for metastatic colorectal cancer in our centre over a period of 12 years. We selected patients who relapsed after radical resection of metastases from colorectal cancer and were deemed resectable again by our multidisciplinary team. We then compared the clinical outcome of those who received a second operation with those who refused surgery and also evaluated the role of prognostic factors.


RESULTS
We identified 60 patients fulfilling the inclusion criteria. Twenty-nine underwent a second resection and 31 refused surgery. Median overall survival rates were 58.7 and 24.0 months, median times to progression were 14.4 and 6.6 months. Patients who received surgery plus perioperatory chemotherapy (18/29) had a significantly better outcome; 4/29 achieved long-term disease-free survival.


CONCLUSIONS
Our study suggests that in highly selected metastatic colorectal cancer patients, a multimodal treatment plan, including a second resection, can achieve longer survival with respect to medical therapy.
Department of Haematology and Oncological Sciences "L. e A. Seràgnoli", University of Bologna, Via Massarenti 9, 40138 Bologna, Italy. giovanni.brandi@unibo.it
Giovanni
G
Brandi
Jody
J
Corbelli
Francesco
F
de Rosa
Stefania
S
Di Girolamo
Ciro
C
Longobardi
Valentina
V
Agostini
Ingrid
I
Garajová
Stefano
S
La Rovere
Giorgio
G
Ercolani
Gian Luca
GL
Grazi
Antonio Daniele
AD
Pinna
Guido
G
Biasco
D014408:Biomarkers, Tumor / Q000032:analysis; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
D014408:Biomarkers, Tumor