gms | German Medical Science

So far, surgical resection of the primary is routinely performed in patients with stage IV colorectal cancer (CRC). Part of these patients can not take advantage of recently improved chemotherapy regimens because of death or other complications as consequence of surgical intervention. Here, we report three cases of complete remission of the primary tumor due to chemotherapy. The patients (64 year old ♀, 57 and 73 year old ♂) were admitted to our clinic because of bloody stools, alternating changes in stool consistence or fatigue combined with weight loss. In all three cases colonoscopy dismantled locally advanced tumors of the recto-sigmoid. Pathological examination showed invasive, moderate differentiated adenocarcinomas in all cases. Abdominal ultrasound and computed tomography revealed polytopic hepatic and pulmonary metastases in two patients and hepatic metastases in one patient. Endoscopic tumor debulking was performed in two of the patients to maintain stool passage and reduce local complications, such as tumor bleeding. Systemic chemotherapy then was started immediately after tumor debulking. During follow up each patient presented in a stable clinical condition. None of them had local complications, such as tumor obstruction or bleeding. Colonoscopic follow up was performed to control macroscopic or histological tumor-growth. Complete remission of the primary was found in all 3 patients after 18, 19 or 23 months, respectively. To date, all patients are alive. One has a complete response of lung and liver metastases and no evidence of residual tumor disease, the others have a partial response of lung or liver metastases. The fact that surgical resection of the primary in stage IV CRC goes along with a highly increased morbidity and mortality, delaying treatment with today`s highly effective chemotherapy regimens, suggests that surgery of the primary may not be contemporary. As shown in this small series of patients endoscopic debulking and instant start of chemotherapy may be an alternative enabling good symptom control. Complete remission of the primary tumor as described in the cases above may even allow to consider surgical treatment of liver metastases.