{
  "abstract": "Importance Local therapy, including surgery, radiation, and ablation, is increasingly used in patients with multiorgan metastatic colorectal cancer (mCRC). However, prospective evidence for a survival benefit of tumor debulking is lacking. Objective To investigate whether tumor debulking added to palliative chemotherapy improves survival of patients with multiorgan mCRC. Design, Setting, and Participants This investigator-initiated, open-label, multicenter, randomized clinical trial enrolled patients with multiorgan mCRC between May 2013 and May 2023. The last date of follow-up was April 4, 2024. Patients were enrolled in 27 hospitals in the Netherlands and 1 in the UK. Adult patients with multiorgan mCRC were considered eligible if more than 80% tumor debulking was deemed feasible by resection, radiotherapy, and/or thermal ablation prior to starting first-line palliative chemotherapy. Interventions After achieving objective tumor response or stable disease after 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil and oxaliplatin with or without bevacizumab, patients were randomized 1:1 to receive chemotherapy alone (standard care group) or tumor debulking followed by chemotherapy. Main Outcomes and Measures The primary end point was overall survival. Secondary end points included progression-free survival and serious adverse events. These outcomes were analyzed in the intention-to-treat population, applicable from randomization. A prespecified interim analysis performed after the initial 100 participants were enrolled revealed that the trial was both safe and feasible to proceed. Results A total of 382 of 454 enrolled patients were randomized: 192 in the chemotherapy alone group (133[69%] male) and 190 in the chemotherapy plus tumor debulking group (127[67%] male). The median age was 64 years in both groups. After a median follow-up of 32.3 months, median overall survival in the chemotherapy alone group was 27.5 months vs 30.0 months in the chemotherapy plus tumor debulking group (adjusted hazard ratio, 0.88 [95% CI, 0.70-1.10]; P=0.26). Median progression-free survival in the chemotherapy alone group was 10.4 months vs 10.5 months in the chemotherapy plus tumor debulking group (adjusted hazard ratio, 0.83 [95% CI, 0.67-1.02]; P=0.08). More patients in the chemotherapy plus tumor debulking vs chemotherapy alone group had any serious adverse events (101 [53%] vs. 74[39%]; P=0.006). Conclusions and Relevance Tumor debulking in addition to first-line palliative systemic treatment failed to improve overall survival compared with systemic treatment alone for patients with multiorgan mCRC and should not be considered standard care.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "name": "Zhang Rongxin"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/50fen5dva58sw.bib",
  "cited_by": 0,
  "doi": "10.19668/j.cnki.issn1674-0491.2026.04.013",
  "fulltext_url": "https://jcas.gxmuyfy.cn/en/wqll/paper.html?id=922267350345060352&cateName=Vol.4%20%20No.32%202026",
  "id": "50fen5dva58sw",
  "issns": [
    "1674-0491"
  ],
  "landing_url": "https://doi.org/10.19668/j.cnki.issn1674-0491.2026.04.013",
  "language": "zh",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RD1-811"
    ],
    [
      "openalex",
      "2730|Colorectal Cancer Treatments and Studies"
    ]
  ],
  "openalex": "W7223686584",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-01",
  "publisher": "Editorial Office of Journal of Colorectal & Anal Surgery",
  "ris": "https://research.draconitic.com/paper/50fen5dva58sw.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:44:37Z",
      "native_id": "e7eeca21f6fc4a2a97e099f588494ab3",
      "source": "doaj",
      "url": "https://doi.org/10.19668/j.cnki.issn1674-0491.2026.04.013"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Colorectal Cancer Treatments and Studies",
      "subfield": "oncology"
    }
  ],
  "title": "[Comment] Tumor debulking in combination with chemotherapy in multiorgan metastatic colorectal cancer: the ORCHESTRA randomized clinical trial",
  "title_text": "[Comment] Tumor debulking in combination with chemotherapy in multiorgan metastatic colorectal cancer: the ORCHESTRA randomized clinical trial",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:44:37Z",
  "url": "https://research.draconitic.com/paper/50fen5dva58sw",
  "venue": "结直肠肛门外科",
  "versions": []
}