Resection of Asymptomatic Primary Tumor with Synchronous Unresectable Colorectal Metastasis—Is It Reasonable?

As much as 30% of colorectal cancers at presentation may have distant metastasis. Asymptomatic primary tumors in the face of synchronous, unresectable metastasis are usually treated with systemic therapy alone. However, data to support or reject primary tumor resection exists and we are yet to come to a definite conclusion. Multiple randomized trials that attempted to address this question failed to accrue adequate patients. The more recent Japanese trial, however, demonstrated a small detriment in overall survival with primary tumor resection. Early cessation of trial with subsequent underpowered results and lack of representation of rectal tumors are key drawbacks of this study. Finally, a balance has to be struck between the risks of tumor-relatedcomplications on systemic therapy with consequent emergency operative morbidity and that of delays in systemic therapy due to primary tumor resection upfront.