Leave it be.
Whether or not to resect an asymptomatic primary colon cancer in the setting of unresectable metastatic disease remains debatable. The phase 3 iPACS trial demonstrated an increase in complications with no increase in survival. The very similar phase 3 CAIRO4 trial now reports more sobering results. Sixty-day mortality after surgery was more than triple (11%) that of the arm without upfront surgery (3%). Post-op death in this time frame was limited to those with abnormal pre-op LDH, LFTs and/or neutrophils, but this likely puts a nail in the coffin for the approach of resected asymptomatic colon cancer when intentionally leaving mets behind. | van der Kruijssen, JAMA Oncol 2021