title: Clinical significance of primary tumor resection in colorectal cancer patients with synchronous unresectable metastasis.
abstract: BACKGROUND
  The aim of this study was to compare the outcomes in colorectal cancer (CRC) patients with synchronous unresectable metastases who received either primary tumor resection (PTR) or chemotherapy as the first treatment and to investigate the clinical course of asymptomatic patients who received chemotherapy as the first treatment.
  
  
  METHODS
  We retrospectively analyzed 324 CRC patients with synchronous unresectable metastases. Overall survival (OS) was analyzed for the two groups (upfront PTR group [n = 72] vs. upfront chemotherapy group [n = 252]). Surgical morbidity and mortality were recorded. In the asymptomatic patients who received upfront chemotherapy, the incidences of primary tumor-related complications were analyzed.
  
  
  RESULTS
  In patients who underwent PTR as the first treatment, the median OS period was superior to those who received upfront chemotherapy (17.2 vs. 13.6 months, P = 0.002). In the PTR group, surgical morbidity and mortality were 11.6% and 1.9%, respectively. Of the 252 asymptomatic patients, the incidence of primary tumor-related complications was 35%. Emergent surgery was ultimately done in 14% of the 252 patients.
  
  
  CONCLUSIONS
  CRC patients with synchronous unresectable metastases who underwent PTR followed by chemotherapy had significantly longer survival times compared to patients who received chemotherapy as the first treatment.
authors.affiliation: Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea.
authors.forename: Min Sung
authors.initials: MS
authors.lastname: Kim
authors.forename: MinKyu
authors.initials: M
authors.lastname: Chung
authors.forename: Joong Bae
authors.initials: JB
authors.lastname: Ahn
authors.forename: Chang Woo
authors.initials: CW
authors.lastname: Kim
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Cho
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Baek
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069287:Capecitabine; D017024:Chemotherapy, Adjuvant; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010071:Oxaloacetates; D010166:Palliative Care / Q000379:methods; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin
keywords: chemotherapy; colorectal neoplasm; primary tumor resection; synchronous unresectable metastasis