title: Surgery in asymptomatic patients with colorectal cancer and unresectable liver metastases: the authors' experience.
abstract: OBJECTIVE
  In asymptomatic patients with Stage IV colorectal cancer, the debate continues over the efficacy of primary resection compared to chemotherapy alone. The aim of this study was to define the optimal management for asymptomatic patients with colorectal cancer and unresectable liver metastases.
  
  
  METHODS
  Patients receiving elective surgery (n = 17) were compared to patients receiving chemotherapy only (n = 31). Data concerning patients' demographics, location of primary tumor, comorbidities, performance status, Child-Pugh score, extension of liver metastases, size of primary, and other secondary locations were collected.
  
  
  RESULTS
  Thirty-day mortality after chemotherapy was lower than that after surgical resection (19.3% versus 29.4%; not significant). In patients with >75% hepatic involvement, mortality at 1 month was higher after receiving surgical treatment than after chemotherapy alone (50% versus 25%). In patients with <75% hepatic involvement, 30-day mortality was similar in both groups (not significant). Thirty-day mortality in patients with Stage T3 was lower in those receiving chemotherapy (16.7% versus 30%; not significant). Overall survival was similar in both groups. The risk of all-cause death after elective surgery (2.1) was significantly higher than in patients receiving chemotherapy only (P = 0.035).
  
  
  CONCLUSIONS
  This study demonstrated that in palliative treatment of asymptomatic unresectable Stage IV colorectal cancer, the overall risk of death was significantly higher after elective surgery compared to patients receiving chemotherapy alone. However, in the literature, there is no substantial difference between these treatments. New studies are required to better evaluate outcomes.
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia.
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gemini
authors.forename: Elisa
authors.initials: E
authors.lastname: Castellani
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Alessia
authors.initials: A
authors.lastname: Corsi
authors.forename: Francesco
authors.initials: F
authors.lastname: Barberini
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Alberto
authors.initials: A
authors.lastname: Santoro
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
authors.forename: Adriano
authors.initials: A
authors.lastname: Redler
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
keywords: 30-day mortality; inoperable liver replacement; large bowel; palliative surgery; tumor