Dr Biachi on the Evolving Role for Surgery in CRC

"The significant improvement in OS that we've [seen over] the past 10 years [in CRC] is not only because of systemic therapy, but because of local therapies, including surgery."

Tiago Biachi, MD, PhD, associate member, Department of Gastrointestinal Oncology, Moffitt Cancer Center; associate professor, University of South Florida, discusses the evolving role for surgery in patients with colorectal cancer (CRC).

The management of CRC is unique among gastrointestinal (GI) tumors, as it relies heavily on a multidisciplinary treatment approach, Biachi begins. Unlike other GI cancers, CRC also presents opportunities for potential cure, even in cases with metastatic disease, he says. This aspect is key in patient discussions, as the disease behaves differently than other GI cancers, requiring close follow-up even after curative treatment, Biachi asserts. He adds that early detection of recurrent lesions enables treatment interventions that can sometimes achieve cure in metastatic cases.

Over the past decade, the significant improvement in median overall survival—from approximately 12 months to more than 30 months—reflects advances in systemic therapies, as well as the evolving role of local interventions, particularly surgery, Biachi continues. In cases where a cure is not feasible, local therapies, such as Y90 ablation or surgical resection, can still provide meaningful benefits, he notes. These treatments offer patients time without chemotherapy, hospital visits, or the constant presence of medical care, ultimately enhancing quality of life (QOL), Biachi details. Moreover, surgical resection of metastatic lesions can greatly improve survival outcomes, he adds.

By extending survival and providing intervals free from continuous treatment, the benefits of local therapies reinforce that CRC is unique among GI tumors, according to Biachi. Their role in improving both survival and QOL emphasizes the need for a multidisciplinary approach to CRC, as well as the importance of ongoing follow-up and individualized care for each patient, Biachi concludes.