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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1992 Jan;74(1):63–67.

Surgical excision alone is adequate treatment for primary colorectal cancer.

R Hind 1, D R Rew 1, C D Johnson 1
PMCID: PMC2497502  PMID: 1736798

Abstract

This debate examines the arguments for and against the proposal that surgical excision alone is adequate treatment for primary colorectal cancer. The arguments in favour are that the results from curative surgery are excellent and that despite many trials of adjuvant chemotherapy, radiotherapy and immunotherapy, the proposed benefits remain unproven. Recent improvements in surgical technique, particularly for dissection of rectal tumours, have shown the way towards further improvement using surgery alone, and it is clear from a national survey that technical factors related to individual surgeons play a large part in determining recurrence rates. With optimum primary treatment, surgical excision alone is indeed adequate therapy. The arguments against this motion are that although a considerable number of patients do survive with surgery, the 5-year survival rate is poor when there is extensive local invasion or lymphatic metastases. Surgery starts therapy by reducing the tumour load, but other modalities are required to destroy the cells which might subsequently develop into metastases. Trial results with adjuvant therapy are encouraging, although many contain too few patients. We cannot be content with the results of treatment of Dukes' Stage B and C tumours; more trials are needed to determine the best treatment for these patients.

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Selected References

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  1. Arnaud J. P., Buyse M., Nordlinger B., Martin F., Pector J. C., Zeitoun P., Adloff A., Duez N. Adjuvant therapy of poor prognosis colon cancer with levamisole: results of an EORTC double-blind randomized clinical trial. Br J Surg. 1989 Mar;76(3):284–289. doi: 10.1002/bjs.1800760322. [DOI] [PubMed] [Google Scholar]
  2. Bentzen S. M., Balslev I., Pedersen M., Teglbjaerg P. S., Hanberg-Soerensen F., Bone J., Jacobsen N. O., Overgaard J., Sell A., Bertelsen K. A regression analysis of prognostic factors after resection of Dukes' B and C carcinoma of the rectum and rectosigmoid. Does post-operative radiotherapy change the prognosis? Br J Cancer. 1988 Aug;58(2):195–201. doi: 10.1038/bjc.1988.192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Buyse M., Zeleniuch-Jacquotte A., Chalmers T. C. Adjuvant therapy of colorectal cancer. Why we still don't know. JAMA. 1988 Jun 24;259(24):3571–3578. [PubMed] [Google Scholar]
  4. Cunliffe W. J., Sugarbaker P. H. Gastrointestinal malignancy: rationale for adjuvant therapy using early postoperative intraperitoneal chemotherapy. Br J Surg. 1989 Oct;76(10):1082–1090. doi: 10.1002/bjs.1800761030. [DOI] [PubMed] [Google Scholar]
  5. Dische S., Saunders M. I. Continuous, hyperfractionated, accelerated radiotherapy (CHART). Br J Cancer. 1989 Mar;59(3):325–326. doi: 10.1038/bjc.1989.64. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fisher B., Wolmark N., Rockette H., Redmond C., Deutsch M., Wickerham D. L., Fisher E. R., Caplan R., Jones J., Lerner H. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst. 1988 Mar 2;80(1):21–29. doi: 10.1093/jnci/80.1.21. [DOI] [PubMed] [Google Scholar]
  7. Galloway D. J., Cohen A. M., Shank B., Friedman M. A. Adjuvant multimodality treatment of rectal cancer. Br J Surg. 1989 May;76(5):440–447. doi: 10.1002/bjs.1800760507. [DOI] [PubMed] [Google Scholar]
  8. Gérard A., Buyse M., Nordlinger B., Loygue J., Pène F., Kempf P., Bosset J. F., Gignoux M., Arnaud J. P., Desaive C. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann Surg. 1988 Nov;208(5):606–614. doi: 10.1097/00000658-198811000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Heald R. J. The 'Holy Plane' of rectal surgery. J R Soc Med. 1988 Sep;81(9):503–508. doi: 10.1177/014107688808100904. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Higgins G. A., Humphrey E. W., Dwight R. W., Roswit B., Lee L. E., Jr, Keehn R. J. Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial II. Cancer. 1986 Jul 15;58(2):352–359. doi: 10.1002/1097-0142(19860715)58:2<352::aid-cncr2820580226>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  11. Higgins G. A., Jr, Amadeo J. H., McElhinney J., McCaughan J. J., Keehn R. J. Efficacy of prolonged intermittent therapy with combined 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel. A Veterans Administration Surgical Oncology Group report. Cancer. 1984 Jan 1;53(1):1–8. doi: 10.1002/1097-0142(19840101)53:1<1::aid-cncr2820530102>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  12. Hobbs J. R. Immunotherapy of human cancers. BMJ. 1989 Nov 11;299(6709):1177–1178. doi: 10.1136/bmj.299.6709.1177. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lockhart-Mummery H. E., Ritchie J. K., Hawley P. R. The results of surgical treatment for carcinoma of the rectum of St Mark's Hospital from 1948 to 1972. Br J Surg. 1976 Sep;63(9):673–677. doi: 10.1002/bjs.1800630902. [DOI] [PubMed] [Google Scholar]
  14. Mayer R. J., O'Connell M. J., Tepper J. E., Wolmark N. Status of adjuvant therapy for colorectal cancer. J Natl Cancer Inst. 1989 Sep 20;81(18):1359–1364. doi: 10.1093/jnci/81.18.1359. [DOI] [PubMed] [Google Scholar]
  15. Moertel C. G. Clinical management of advanced gastrointestinal cancer. Cancer. 1975 Aug;36(2):675–682. doi: 10.1002/1097-0142(197508)36:2+<675::aid-cncr2820360810>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  16. Moertel C. G., Fleming T. R., Macdonald J. S., Haller D. G., Laurie J. A., Goodman P. J., Ungerleider J. S., Emerson W. A., Tormey D. C., Glick J. H. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med. 1990 Feb 8;322(6):352–358. doi: 10.1056/NEJM199002083220602. [DOI] [PubMed] [Google Scholar]
  17. Panettiere F. J., Goodman P. J., Costanzi J. J., Cruz A. B., Jr, Vaitkevicius V. K., McCracken J. D., Brownlee R. W., Laufman L., Stephens R. L., Bonnet J. Adjuvant therapy in large bowel adenocarcinoma: long-term results of a Southwest Oncology Group Study. J Clin Oncol. 1988 Jun;6(6):947–954. doi: 10.1200/JCO.1988.6.6.947. [DOI] [PubMed] [Google Scholar]
  18. Phillips R. K., Hittinger R., Blesovsky L., Fry J. S., Fielding L. P. Local recurrence following 'curative' surgery for large bowel cancer: I. The overall picture. Br J Surg. 1984 Jan;71(1):12–16. doi: 10.1002/bjs.1800710104. [DOI] [PubMed] [Google Scholar]
  19. Rew D. A., Wilson G. D., Taylor I., Weaver P. C. Proliferation characteristics of human colorectal carcinomas measured in vivo. Br J Surg. 1991 Jan;78(1):60–66. doi: 10.1002/bjs.1800780120. [DOI] [PubMed] [Google Scholar]
  20. Sugarbaker P. H., Gianola F. J., Speyer J. C., Wesley R., Barofsky I., Meyers C. E. Prospective, randomized trial of intravenous versus intraperitoneal 5-fluorouracil in patients with advanced primary colon or rectal cancer. Surgery. 1985 Sep;98(3):414–422. [PubMed] [Google Scholar]
  21. Tannock I. F. Experimental chemotherapy and concepts related to the cell cycle. Int J Radiat Biol Relat Stud Phys Chem Med. 1986 Feb;49(2):335–355. doi: 10.1080/09553008514552581. [DOI] [PubMed] [Google Scholar]
  22. Taylor I., Machin D., Mullee M., Trotter G., Cooke T., West C. A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer. Br J Surg. 1985 May;72(5):359–363. doi: 10.1002/bjs.1800720509. [DOI] [PubMed] [Google Scholar]
  23. Umpleby H. C., Williamson R. C. Anastomotic recurrence in large bowel cancer. Br J Surg. 1987 Oct;74(10):873–878. doi: 10.1002/bjs.1800741003. [DOI] [PubMed] [Google Scholar]
  24. Williams N. S. Changing patterns in the treatment of rectal cancer. Br J Surg. 1989 Jan;76(1):5–6. doi: 10.1002/bjs.1800760104. [DOI] [PubMed] [Google Scholar]
  25. Windle R., Bell P. R., Shaw D. Five year results of a randomized trial of adjuvant 5-fluorouracil and levamisole in colorectal cancer. Br J Surg. 1987 Jul;74(7):569–572. doi: 10.1002/bjs.1800740707. [DOI] [PubMed] [Google Scholar]
  26. Wolmark N., Fisher B., Rockette H., Redmond C., Wickerham D. L., Fisher E. R., Jones J., Glass A., Lerner H., Lawrence W. Postoperative adjuvant chemotherapy or BCG for colon cancer: results from NSABP protocol C-01. J Natl Cancer Inst. 1988 Mar 2;80(1):30–36. doi: 10.1093/jnci/80.1.30. [DOI] [PubMed] [Google Scholar]

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