Treatment strategies in synchronous metastatic colon cancer

Background Colon cancer is aggressive and shows a high tendency to metastatic dissemination. Objective Treatment decision making in the presence of potentially resectable metastases or asymptomatic primary tumors with synchronous irresectable metastases is difficult. Methods The current evidence regarding the treatment of synchronous metastatic colon carcinoma is summarized. Results Resectable liver, lung or peritoneal metastases should be primarily resected. Potentially resectable metastases should be treated by a chemotherapy doublet as well as targeted antibodies and if secondarily resectable, surgical treatment should be performed (conversion therapy). If nonresectable metastases are present in the treatment setting of palliative chemotherapy, a survival benefit through primary tumor resection (PTR) currently seems unlikely. Conclusion Every patient with metastatic colon cancer should be referred for a second opinion at a metastatic surgery center. In the presence of certain risk factors for primary tumor-associated complications under chemotherapy, PTR can be indicated.