The benefit of surgical management of colorectal carcinoma bone metastases

Abstract

Background/Objective: Metastatic colorectal carcinoma to bone rarely requires surgical intervention, and is infrequently studied. Aggressive surgical resection is sometimes empirically recommended in these patients, although there is no proven benefit for patient survival. Our hypothesis was that there is survival advantage conferred by resecting bone metastases (BM) when surgery is necessary.

Methods: We performed a retrospective review of a prospectively collected database and identified 39 patients with bone metastases in the appendicular skeleton requiring surgery. Patients underwent surgery because of intractable pain, impending pathologic fracture, and/or pathologic fracture at presentation.

Results: Median survival after complete resection of bone metastasis was higher (8 months) than for patients who had surgery, but did not have bony metastases completely excised (3 months, p = 0.014); and in surgical patients who had solitary bone metastasis at presentation (p = 0.023) compared with multiple bone involvement. There were no perioperative deaths. Additional skeletal surgeries were only required for patients (4 out of 39) with local recurrences. In cases of local recurrence, the median time to progression was 19 months.

Conclusions: Surgery for bone metastasis in colorectal carcinoma is well tolerated, and can be considered for palliative care. Compared with other surgical techniques, complete bone-metastasis resection is associated with longer overall survival, and with longer recurrence free survival.