The Management Of The Primary Tumor In Patients With Metastatic Colorectal Cancer

Over the past decade, the role of surgery in stage IV colorectal cancer (CRC) has evolved, yet the optimal surgical management of the primary tumor in patients with metastatic CRC that is not amenable to curative resection is unknown. A high rate of surgical resection of the primary tumor has been reported in patients with unresectable metastatic disease. Resection of the primary tumor in patients with metastatic CRC is often performed to deal with presenting primary tumor symptoms and or to prevent future primary tumor complications. Nevertheless, with access to novel agents and their efficacy in the primary tumor as well as lack of major complications related to an intact primary tumor, surgery is less commonly performed today. Although the data regarding survival advantages of resection of the primary tumor are inconsistent, overall the evidence suggests potential survival benefit of removal of the primary tumor in patients with both symptomatic and asymptomatic primary tumors even with access to more effective combination chemotherapy. However, the published literature favoring surgery mostly comprises retrospective observational studies. Consequently, the survival benefit related to surgery has been attributed to selection bias, and in the absence of randomized controlled trial no definite conclusion can be drawn. Currently, two randomized controlled trials are enrolling patients to answer this important question in the management of metastatic CRC.