To the Editor Hu et al1 report improved survival for patients with metastatic colorectal cancer over time and note that this corresponds to a decrease in the rate of surgery for the primary lesion. Based on the data, they suggest that resections for synchronous primary lesions may be overused. There are a number of concerns in making such a broad conclusion. Improved survival from metastatic colorectal cancer has occurred because of a combination of factors, including the improved use of systemic therapy and metastasectomy.2 Partly based on the advances in systemic therapy associated with significantly higher response rates, a review of the role of primary resection has occurred. Data were emerging that suggested that the risk of complications related to withholding resection of the primary lesion was no higher than the risk of having surgery prior to chemotherapy.3 This had led to more clinicians deferring resection of the primary lesion.
Price TJ, Tebbutt N, Townsend AR. Less Surgery, Improved Survival From Stage IV Colorectal Cancer?. JAMA Surg. 2015;150(8):818. doi:10.1001/jamasurg.2015.0680