The Role of Surgery of the Primary Tumour in Patients With Synchronous Unresectable Metastases of Colorectal Cancer

The clinical benefit of resection of the primary tumour in patients with synchronous unresectable metastases is not known. In the literature studies usually describe retrospective selected patients with synchronous metastases treated with or without resection of the primary tumour. All these studies are biased in patient selection and there are no prospective randomized studies on this topic. In patients with few or absent symptoms of the primary tumour, arguments both in favour and against initial resection have been presented, and therefore a randomized trial is warranted. Although recent publications suggest that resection of the primary tumour in synchronous metastasized colon cancer patients might not be necessary, this appears to be based on feasibility and not on clinical outcome. Several studies comparing large groups of patients with or without resection of the primary tumour suggest an improved survival when the primary tumour is resected. A potential benefit of resection of the primary tumour is to prevent complications of the primary tumour during chemotherapy treatment or during later stages of the disease. A recent analysis of the CAIRO and CAIRO2 data showed that metastatic colon cancer patients who had a resection of the primary tumour prior to study entry, had an improved survival compared to patients without a resection of the primary tumour. However, these patients were selected after the primary tumour was resected and therefore these results are not corrected for surgical morbidity and mortality. The investigators here propose a randomized trial in order to demonstrate that resection of the primary tumour does improve overall survival.

同步不可切除转移瘤患者中行原发肿瘤切除术的临床获益尚未明确。现有文献研究多为回顾性筛选接受或未接受原发肿瘤切除的同步转移瘤患者，此类研究均存在患者选择偏倚，目前尚无针对该主题的前瞻性随机对照研究。对于原发肿瘤症状轻微或无症状的患者，支持与反对初始切除的论据均已提出，因此有必要开展随机对照试验。尽管近期研究提示，同步转移性结直肠癌患者或无需行原发肿瘤切除，但该结论似乎仅基于手术可行性，而非临床结局。多项对比大样本接受/未接受原发肿瘤切除患者的研究显示，切除原发肿瘤可改善患者生存。原发肿瘤切除术的潜在获益之一，是可预防化疗期间或疾病后期出现的原发肿瘤相关并发症。近期对CAIRO与CAIRO2数据的分析显示，入组前接受原发肿瘤切除的转移性结直肠癌患者，其生存情况优于未接受该手术的患者。但此类患者是在原发肿瘤切除完成后才被筛选纳入研究的，因此上述结果未校正手术相关并发症的发病率与死亡率。本研究团队拟开展一项随机对照试验，以证实原发肿瘤切除术确实可改善患者的总体生存期。