Reply: apples, oranges, metastatic colorectal cancer: has the time for a randomized trial come?

Abstract

[extract] We appreciate the interest expressed by authors Hassan and Advanti, as well as Katsios and Baltogiannis in our meta-analysis. We acknowledge that although our meta-analysis is based on the best retrospective comparative data available, it is still subject to bias, in particular confounding. This can cause difficulty in the interpretation of the results and prevents robust conclusions regarding the most appropriate management of patients with metastatic colorectal cancer. Without any doubt, a randomized control trial is necessary to draw solid conclusions about the appropriate management of patients with colorectal cancer and unresectable synchronous metastatic disease. Unfortunately, without such information available we must base our clinical decisions on the "fruit salad" of information that is currently available. Our meta-analysis, based on 8 comparative studies, including 1,062 patients, concluded that many asymptomatic or minimally symptomatic patients are likely to benefit from resection of their primary tumor. We feel that palliative resection of the primary tumor should be considered as a first-line treatment option. However, this must be done in light of known prognostic factors that indicate an improved survival and lower postoperative morbidity and mortality.