Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press13810.17650/2220-3478-2015-5-3-9-14REVIEWОБЗОРЫ ЛИТЕРАТУРЫDoes asymptomatic primary tumor need to be removed in unresectable metastatic colon cancer?Необходимо ли удаление бессимптомной первичной опухоли при нерезектабельном метастатическом раке толстой кишки?FedyaninM. Yu.ФедянинМ. Ю.
Russian Federation
fedianinmu@mail.ruTryakinA. A.ТрякинА. А.
Russian Federation
TyulyandinS. A.ТюляндинС. А.
Russian Federation
N.N. Blokhin Russian Cancer Research Center at the Ministry of Health of RussiaФГБУ «Российский онкологический научный центр им. Н. Н. Блохина» Минздрава России23 Kashirskoe Shosse, Moscow, 115478, RussiaРоссия, 115478, Москва, Каширское шоссе, 2308102015539140810201508102015Copyright ©; 2015, Fedyanin M.Y., Tryakin A.A., Tyulyandin S.A.Copyright ©; 2015, Федянин М.Ю., Трякин А.А., Тюляндин С.А.2015Fedyanin M.Y., Tryakin A.A., Tyulyandin S.A.Федянин М.Ю., Трякин А.А., Тюляндин С.А.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/138

Every third colorectal cancer patient has inoperable metastatic disease upon diagnosis. And quite often the primary tumor is asymptomatic. The question stands for surgeon and medical oncologist, whether to proceed with upfront surgery or systemic chemotherapy. Considering the absence of prospective randomized clinical trials, we must discuss all potential benefits and drawbacks of both approaches, biological interactions between the primary tumor and metastases, risk of complications, associated with primary tumor during chemotherapy, relative efficacy of chemotherapy for primary tumor and metastatic nodes, we must perform a retrospective analysis of prognostic value of primary tumor resection. This review discusses all of the aforementioned questions.

На момент постановки диагноза «рак толстой кишки» у трети пациентов выявляются отдаленные метастазы неоперабельного характера. Нередко первичная опухоль в толстой кишке имеет бессимптомное течение. Соответственно, перед хирургом и химиотерапевтом встает вопрос: удалять первичную опухоль или безотлагательно начинать химиотерапию (ХТ)? В условиях отсутствия результатов проспективных рандомизированных исследований, посвященных решению данного вопроса, необходимо рассмотреть все аргументы «за» и «против» удаления первичной опухоли: биологические особенности взаимоотношения первичной опухоли и метастазов, риск развития осложнений со стороны первичной опухоли в процессе ХТ, действует ли ХТ в равной степени на метастазы и на первичную опухоль, необходимо провести анализ ретроспективных исследований прогностического значения удаления первичной опухоли при наличии метастазов. Изучению данных аспектов и посвящен настоящий обзор литературы.

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