Abstract
Patients with metastatic colorectal cancer can only be cured when the primary tumour in the colorectum and all its metastases are removed. This is primarily the case when the metastases are confined to the liver. This thesis shows that although the amount of patients that underwent this type of surgery has increased strongly since the early 90s, there is still a large variation in the proportion of patients with hepatic metastases that undergo liver metastasectomy. This suggest that more consultation between specialists, on both regional and national level, could lead to an improvement in the identification of patients who are eligible for liver resection, and thus might even lead to an improvement in overall survival.
Nevertheless, the majority of patients with metastatic colorectal cancer is only eligible for palliative treatment. Currently, the value of palliative primary tumour resection in synchronous mCRC patients with few or absent symptoms is under discussion. The proportion of patients who undergo a palliative colorectal resection is decreasing. Retrospective studies, however, show a potential survival benefit of 6 months, which suggests that there might be a role for resection of the primary tumour even when patients have little to no symptoms. This thesis further disproves the general assumption that patients with metastatic disease have an increased risk of perioperative complications. In recent years, mortality rates of colorectal surgery are comparable for patients with and without metastatic disease. Important predictors of 30-day mortality are increased age, the presence of comorbidity and the location of the tumour. The decision to perform palliative colorectal surgery should therefore be based on an individualized risk and after comprehensive counselling of a patient.
This thesis is the result of extensive epidemiologic research performed at the Department of Surgical Oncology of the Radboud University in Nijmegen and the Department of Medical Oncology of the University Medical Center in Utrecht.
