Aggressive surgical resection of the primary tumor without metastasectomy first in stage IV colon cancer with unresectable synchronous liver-only-metastases patients cannot provide the survival benefits compared with chemotherapy first

Background: Controversy exists over whether aggressive surgical resection of the primary tumor without metastasectomy first or chemotherapy first in stage IV colon cancer with unresectable synchronous liver-only-metastases (CLM) improves patients. Materials and Methods: We retrospectively reviewed the outcome of 156 patients initially diagnosed with unresectable synchronous CLM who were under treatment in our institution from January 2004 to December 2012. Patients with extrahepatic diseases or previous hepatic resection were excluded. All patients with a follow-up of at least 3 months were included. Progression-free survival (PFS) and 5-year overall survival (OS) curves were calculated using the Kaplan–Meier method. Results: Among the 156 patients with CLM, 43 (27.56%) received aggressive surgical resection of the primary tumor without metastasectomy first, 113 (72.43%) received systemic chemotherapy first. At 5 years, the adjusted PFS and OS in stage IV colon cancer with inoperable metastases were 24.2% and 20.4%, respectively, in the surgical resection of the primary tumor first group and 46.0% and 16.9% in the chemotherapy first group ( P = 0.515 and P = 0.742, respectively). In multivariate analysis, there was no statistical difference in the PFS and 5-year OS between the surgical resection of the primary tumor first group and chemotherapy first. Conclusion: Surgical resection of the primary tumor without metastasectomy first in CLM is not associated with improved survival as compared with chemotherapy first. Additional research is necessary to determine which patients may benefit from this intervention.