Surgical resection of primary tumors in patients with stage IV colorectal cancer and unresectable liver metastases

Introduction: The optimal surgical strategy for treating colorectal cancer with stage IV is controversial. We evaluated the use of primary tumor resection in patients with stage IV colorectal cancer and unresectable liver metastases. Methods: A retrospective review was performed of 156 patients with unresectable colorectal liver metastases. These patients were treated in a single institution between 2004 and 2011. Patients undergoing primary tumor resection were analyzed. We compared the survival of resected and nonresected patients. Results: A total of 99 (63%) of the 156 patients presenting with stage IV colorectal cancer underwent primary tumor resection. 66 patients underwent resection of primary colorectal cancer initially (at diagnosis of disease) and 33 patients underwent resection of primary colorectal cancer after one month of diagnosis of stage IV colorectal cancer. Patients undergoing resection had higher median survival rates when compared with patients who did not undergo resection (No resected: 5 months, vs. resected during the first month: 16 months and resected after one month: 13 months, P = 0,003). Conclusion: Most patients who present with incurable stage IV colorectal cancer undergo resection of the primary tumor. When compared with patients who did not undergo resection overall survival was better in patients undergoing resection. The results of this review support primary tumor resection in stage IV colorectal cancer.