title: Primary tumor resection in colorectal cancer with unresectable synchronous metastases: A review.
abstract: At the time of diagnosis, 25% of patients with colorectal cancer (CRC) present with synchronous metastases, which are unresectable in the majority of patients. Whether primary tumor resection (PTR) followed by chemotherapy or immediate chemotherapy without PTR is the best therapeutic option in patients with asymptomatic CRC and unresectable metastases is a major issue, although unanswered to date. The aim of this study was to review all published data on whether PTR should be performed in patients with CRC and unresectable synchronous metastases. All aspects of the management of CRC were taken into account, especially prognostic factors in patients with CRC and unresectable metastases. The impact of PTR on survival and quality of life were reviewed, in addition to the characteristics of patients that could benefit from PTR and the possible underlying mechanisms. The risks of both approaches are reported. As no randomized study has been performed to date, we finally discussed how a therapeutic strategy's trial should be designed to provide answer to this issue.
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Louis
authors.initials: L
authors.lastname: de Mestier
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Manceau
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Cindy
authors.initials: C
authors.lastname: Neuzillet
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Bachet
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Spano
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Kianmanesh
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Jean Christophe
authors.initials: JC
authors.lastname: Vaillant
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouché
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Hannoun
authors.affiliation: Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Karoui
keywords: Chemotherapy; Colorectal cancer; Colorectal primary tumor; Colorectal surgery; Liver metastases; Survival