Resecting the asymptomatic colon cancer primary in stage IV disease with unresectable metastases

Many patients with synchronous metastatic colorectal cancer (CRC) are asymptomatic from the primary tumor. While primary tumor resection is indicated for symptoms including bleeding, obstruction, and perforation, the role for asymptomatic primary tumor resection has been debated. Studies in favor of and against primary tumor resection are reviewed. Unlike previously published non-randomized studies, whose results may have been strongly influenced by selection bias, recently published randomized controlled trials suggest that primary tumor resection in Stage IV CRC with an asymptomatic primary and unresectable metastatic disease does not provide a survival benefit to the patient.