Review
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World J Gastrointest Oncol. Jun 15, 2014; 6(6): 156-169
Published online Jun 15, 2014. doi: 10.4251/wjgo.v6.i6.156
Primary tumor resection in colorectal cancer with unresectable synchronous metastases: A review
Louis de Mestier, Gilles Manceau, Cindy Neuzillet, Jean Baptiste Bachet, Jean Philippe Spano, Reza Kianmanesh, Jean Christophe Vaillant, Olivier Bouché, Laurent Hannoun, Mehdi Karoui
Louis de Mestier, Olivier Bouché, Department of Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, 51100 Reims, France
Gilles Manceau, Jean Christophe Vaillant, Laurent Hannoun, Mehdi Karoui, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, University Institute of Cancerology (Paris VI), Pierre and Marie Curie University, 75013 Paris, France
Cindy Neuzillet, Assistance Publique-Hôpitaux de Paris, Department of Gastroenterology and Pancreatology, Beaujon University Hospital, 92110 Clichy, France
Jean Baptiste Bachet, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Gastroenterology, University Institute of Cancerology (Paris VI), Pierre and Marie Curie University, 75013 Paris, France
Jean Philippe Spano, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Medical Oncology, University Institute of Cancerology (Paris VI), Pierre and Marie Curie University, 75013 Paris, France
Reza Kianmanesh, Department of Digestive and Endocrine Surgery, Robert-Debré University Hospital, 51100 Reims, France
Author contributions: de Mestier L, Manceau G, Neuzillet C, Bachet JB, Spano JP, Kianmanesh R, Vaillant JC, Bouché O, Hannoun L and Karoui M designed research; de Mestier L, Manceau G, Karoui M performed research; de Mestier L, Manceau G and Karoui M analyzed data; de Mestier L, Manceau G, Neuzillet C, Bachet JB, Spano JP, Kianmanesh R, Vaillant JC, Bouché O, Hannoun L and Karoui M wrote the paper.
Correspondence to: Mehdi Karoui, MD, PhD, Professor of Surgery, Assistance Publique-Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Department of Digestive and Hepato-Pancreato-Biliary Surgery, University Institute of Cancerology (Paris VI), Pierre and Marie Curie University, 47-83 Boulevard de l’Hôpital, 75013 Paris, France. mehdi.karoui@psl.aphp.fr
Telephone: +33-1-42175612 Fax: +33-1-42175613
Received: November 17, 2013
Revised: April 8, 2014
Accepted: May 13, 2014
Published online: June 15, 2014
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.

Keywords: Colorectal cancer, Colorectal surgery, Chemotherapy, Colorectal primary tumor, Survival, Liver metastases

Core tip: The present review aimed to analyze all published data on whether primary tumor resection should be performed before chemotherapy administration in patients with colorectal cancer and unresectable synchronous metastases.