Present and future role of surgery in metastatic gastrointestinal malignancies

Metastases from gastrointestinal malignancies are systemic or abdominal disseminations of cancer cells. From a biological perspective surgical resections are questionable but case series show that for some tumour types, surgery influences survival outcome. This review focuses on management and indications for surgery in recent literature of these metastatic gastrointestinal malignancies.

A few gastrointestinal malignancies have emerged to be candidates for surgery in case of metastatic disease. Surgery can be considered in selected cases with liver metastases or abdominal dissemination of colorectal cancer, metastases from gastrointestinal stromal tumours or neuroendocrine tumours. On the contrary, recent publications do not support surgery for metastatic disease of any other gastrointestinal origin. The literature has ample examples of small series and anecdotal cases of successful surgical interventions for most tumour types but no new evidence has been presented to support broader indications for surgery.

The evidence base for surgery of different metastatic gastrointestinal malignancies is unchanged. There are some clarifications when to perform surgery and the timing of surgery in regard to combined treatments. No new tumour types are added to potential candidates for surgery.