Primary Tumor Resection in Patients With Unresectable Metastatic Colorectal Cancer: A Systematic Review and...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• The role of primary tumor resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) is debated.
• Previous reviews included symptomatic patients or inconsistent chemotherapy, limiting conclusions.

Purpose of the Study:

• To evaluate the benefit of PTR in asymptomatic, unresectable mCRC.
• To compare survival outcomes and complications between PTR and chemotherapy alone.

Main Methods:

• Systematic review adhering to PRISMA guidelines.
• Included studies with asymptomatic mCRC and modern chemotherapy.
• Primary outcome: overall survival (OS); Secondary outcomes: progression-free survival (PFS), complications, mortality, emergency interventions.

Main Results:

• 17 studies (9317 patients) analyzed; 5581 had PTR, 3736 did not.
• PTR showed no significant improvement in OS (HR 1.10) or PFS (HR 0.89).
• PTR group: 19.8% morbidity, 2.0% 30-day mortality. Non-resection group: 6.4% required emergency surgery with 5.3% 30-day mortality.

Conclusions:

• Upfront PTR does not enhance survival in asymptomatic unresectable mCRC.
• PTR introduces significant perioperative risks.
• Individualized treatment decisions are recommended over routine PTR.