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Colorectal cancer is a common form of cancer that can spread to other parts of the body. Some patients need surgery to remove the original tumor—called primary tumor resection (PTR)—because of symptoms like bleeding or blockage. However, in patients without serious symptoms, whose cancer has already spread too far to be removed, and who are treated with chemotherapy to relieve symptoms and prolong life rather than cure the disease (palliative systemic therapy), it has long been unclear whether surgery offers any benefit.

This thesis explored whether PTR helps these patients live longer, and whether the effect depends on where the tumor started—on the left or right side of the colon. Left-sided tumors are generally linked to better outcomes than right-sided ones.
Although information from a large national database suggested that PTR might be more beneficial in patients with left-sided colon cancer, this was not confirmed in a large randomized trial (CAIRO4), which found no clear survival benefit from surgery, regardless of the location of the tumor. In fact, early deaths were more common in patients who had surgery, especially among those with abnormal blood test results.
The research also showed that left- and right-sided colon cancers tend to spread differently. For example, right-sided cancers more often spread to the lining of the abdomen, while rectal cancer more frequently spreads to the lungs.
These findings suggest that routine removal of the primary tumor should not be standard practice in patients with advanced, incurable colorectal cancer who do not have serious symptoms of the original tumor.