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Surgical risk more significant than timing for colon cancer patients

Doctor decisions to remove primary and secondary tumors in one or more procedures requires patient-specific determinations.

By Stephen Feller
Surgical risk more significant than timing for colon cancer patients
About 20 percent of all colon cancers have spread to other organs, most often the liver, before they are diagnosed. Image courtesy of Mayo Clinic

ROCHESTER, Minn., Aug. 31 (UPI) -- Because a high rate of colorectal cancers have spread beyond the colon by the time they are diagnosed, researchers often have to find the best way to attack two separate tumors -- which can complicate the treatment process.

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.

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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, researcher and general surgeon at Mayo Clinic, said in a press release.

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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.

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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.

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"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.

The study is published in the Journal of Gastrointestinal Surgery.

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