Improved Outcomes in Colon and Rectal Surgery part 32

- Resection of liver metastases in colorectal cancer–competitive analysis of treatment results in synchronous versus metachronous metastases.
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- Major hepatectomy in patients with synchronous colorectal liver metastases:.
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- Until recently, this course of therapy was the standard of care for patients with advanced colorectal cancer.
- It was first introduced to treat patients with recurrent or meta- static colorectal cancer that was otherwise unresectable.
- IFL therapy (5-FU, leucovorin and irinotecan) has been shown to be superior to 5FU/leucovorin therapy alone in patients with metastatic colorectal cancer.(12) However, the N9741 Intergroup trial described above showed that patients treated with FOLFOX had superior results to those treated with FOLFIRI (5-FU and irinotecan), or IROX(irinotecan and oxaliplatin).(10) Based on the results of this and other studies irinotecan containing com- binations are now mostly used as second line therapy.(13) Bevacizumab (AVASTIN®).
- Cetuximab (a monoclonal antibody blocking epidermal growth factor (EGFR) is currently approved only as therapy as a single agent or in combination with irinotecan for patients with previ- ously treated advanced colorectal cancer.
- The first large-scale trial to demonstrate a sur- vival benefit for adjuvant chemotherapy in colon cancer, National Surgical Adjuvant Breast and Bowel project (NSABP) C-01 included 1,166 patients with Dukes’ B or C colon cancer.(19) The patients randomized to adjuvant MOF chemotherapy instead of surgery alone had significant improvement in their 5-year overall survival..
- Clinical data indicates that access to a multidrug regimen consisting of two or more of the agents dis- cussed earlier (in addition to 5-FU therapy) has almost doubled median survival in the patients with advanced colorectal cancer from 10–12 months to more than 20 months..
- In contrast to the clear benefit of adjuvant chemotherapy for patients with node-positive disease, its role in resected stage II colon cancer remains controversial.
- (http://cancer.gov)..
- The Swedish Rectal Cancer Trial examined whether neoad- juvant preoperative radiation therapy was of benefit to patients with advanced rectal cancer.
- A European trial randomly assigned 762 patients with T3/4 rectal cancer within reach of the digital rectal exam to either preoperative radiotherapy alone or preoperative chemoradio- therapy.
- The benefits of modern chemotherapy with regards to its abil- ity to delay disease progression and improve survival in patients with advanced colon and rectal cancer are unquestionable..
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- and levamisole in patients with Dukes’ B and C carcinoma of the colon: results from National Surgical Adjuvant Breast and Bowel Project C-04.
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- A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer.
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- Adjuvant therapy of colorectal cancer.
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- Comparative efficacy of adjuvant chemotherapy in patients with Dukes’.
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- Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer.
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