To the Editor We were surprised at the conclusions reached by Hu et al1 in their analysis of rates of primary tumor resection (PTR) and of survival of patients with metastatic colorectal cancer (MCRC) over time. Specifically, they have concluded that decreasing rates of PTR have directly contributed to the observed improvement in overall survival for patients with MCRC over a 22-year period, despite not providing an explanation as to how these 2 seemingly distinct data points are linked and despite an obvious alternative explanation for survival gains.
Wong R, Gibbs P. Less Surgery, Improved Survival From Stage IV Colorectal Cancer?. JAMA Surg. 2015;150(8):818-819. doi:10.1001/jamasurg.2015.1331