Primary tumor surgery in de novo metastatic breast cancer: Game-changer or misinterpretation?

The study titled "Primary tumor surgery in patients with de novo metastatic breast cancer: a nationwide population-based retrospective cohort study in Belgium" opens an important discussion about the potential role of surgery in the treatment of de novo MBC; although the results are promising, they should be interpreted with caution given the limitations of the study design. The question remains whether surgery is truly a game-changer for all patients or whether its benefits are more nuanced depending on individual patient factors and disease characteristics. As the oncology community continues to explore this question, a modern breast surgeon should emphasize the importance of further prospective trials and personalized treatment strategies that consider not only surgery but also the growing arsenal of available systemic therapies.