Real-world outcomes with curative-intent metastasectomy in colorectal cancer patients

Long-term survival in metastatic colorectal cancer (mCRC) can be achieved by curative-intent metastasectom. Patient ineligible for primary metastasectomy (PM) may become candidates for secondary metastasectomy (SM) following response to primary chemotherapy (PCT), still with curative intent. Most studie focus either on resectable or unresectable mCRC, limiting insights into differential subgroup benefits. A retrospective study at the Comprehensive Cancer Center of the LMU Hospital (Munich, Germany) analysed real-world outcomes of mCRC patients from 2007 to 2021. Among 840 evaluable patients, 166 (20%) underwent PM, 520 (62%) received PCT), and 109 (13%) became eligible for SM after response to systemic treatment. Overall survival (OS) was significantly longer for PM versus PCT patients (median 82.3 versus 41.6 months; HR 0.47; p<0.0001); multivariate analysis confirmed this benefit across all subgroups, including high risk groups of right-sided and multisite mCRC patients. OS was comparable between PM and SM patients (median 82.3 versus 80.9 months), whereas patients ineligible for local treatments had the worst OS (median 25 months). The authors conclude that both PM and SM were associated with excellent OS, also among high-risk mCRC patients.