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Hépato-Gastro & Oncologie Digestive

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Asymptomatic colon cancer with unresectable synchronous liver metastases: should the primary tumor be resected? Volume 20, issue 6, Juin 2013

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Authors
Hôpital Pitié Salpêtrière, service de chirurgie digestive et hépato-bilio-pancréatique, Institut Universitaire de Cancérologie Pierre et Marie Curie (Paris VI), 42-83 Bd de l’Hôpital, 75013 Paris, France, Hôpital Pitié Salpêtrière, service d’hépato-gastroentérologie, Institut Universitaire de Cancérologie Pierre et Marie Curie (Paris VI), 42-83 Bd de l’Hôpital, 75013 Paris, France, Hôpital Pitié Salpêtrière, service d’oncologie médicale, Institut Universitaire de Cancérologie Pierre et Marie Curie (Paris VI), 42-83 Bd de l’Hôpital, 75013 Paris, France, Hôpital Pitié Salpêtrière, service d’anatomie et de cytologie pathologique, Institut Universitaire de Cancérologie Pierre et Marie Curie (Paris VI), 42-83 Bd de l’Hôpital, 75013 Paris, France, Hôpital Pitié Salpêtrière, service de radiologie, Institut Universitaire de Cancérologie Pierre et Marie Curie (Paris VI), 42-83 Bd de l’Hôpital, 75013 Paris, France

At diagnosis, 25% of patients with colorectal cancer have synchronous metastases, mainly liver metastases. In most cases, metastases are considered unresectable and treatment is based on chemotherapy with biotherapy. In these patients, when colon tumor is asymptomatic or pauci-symptomatic, the interest of primary tumor resection before initiating chemotherapy remains controversial. No prospective randomized study is available to help clarify this issue. The aim of this work is to review the data available in the literature to guide the choice of initial treatment (colectomy yes vs. no) in patients with colon cancer and unresectable synchronous metastases, by focusing on three elements of discussion: the risks of unresected primary tumor-related complications under chemotherapy, the risk of complications after palliative primary tumour resection in metastatic setting and the impact of the strategy on survival.