Resection of primary lesion for patients with metastatic breast cancer: where are we now?

It is largely unclear that whether or not surgical resection of the primary tumors could confer survival benefit among patients with metastatic breast cancer at initial presentation. We thoroughly reviewed the up-to-date evidence on surgical resection of the primary lesion in metastatic breast cancer, including comparative studies (of particular interest in risk modifiers, the type, and timing of surgical procedures), Chinese and international guidelines, as well as the progress of clinical trials. Partial modified radical mastectomy and breast-conserving surgery are by far the most common choices for patients with metastatic breast cancer. Patients with certain characteristics, for example, younger than 45 years of age or with oligo-metastasis, might benefit from the surgery. The type and timing of surgical procedures are still in debate according to the guidelines from different countries. Forthcoming evidence from the ongoing clinical trials might help close the knowledge gaps in surgical treatment for patients with metastatic breast cancer and aid the decision-making in clinical practice.