Surgery before chemo for advanced rectal cancer? small trial offers few answers

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Non-complicated primary tumor (i.e. tumor without obstruction, bleeding, abscess or perforation requiring emergency surgery and/or contra-indicating first-line chemotherapy) * Unresectable synchronous metastases * ECOG performance status 0-1 * Rectal adenocarcinoma (\<15 cm from the anal verge) with few or no symptoms and unresectable metastasis (assessed by the investigator) unsuitable for curative treatment * No known unresectable primary tumor (with clear margin \>1mm) on CT-scan and MRI * No disease progression under chemotherapy (for at least 4 cycles); * Assessment of KRAS status before randomization (wild type or mutated); * Life expectancy without cancer \>2 years * White blood cell count ≥ 3 x 109/L, with neutrophils ≥ 1,5 x 109/L, platelet count ≥ 100 x 109/L, hemoglobin°≥ 9 g/dL (5,6 mmol/l) * Total bilirubin ≤ 1.5 x ULN (upper limit of normal), ASAT and ALAT ≤ 2.5 x ULN, alkaline phosphatase°≤°1.5°x ULN, serum creatinine ≤ 1.5 x ULN; * Age ≥ 18 years ≤ 75 years * Patients with childbearing potential should use effective contraception during the study and up 6 months after the end of chemotherapy * Covered by a Health System where applicable, and/or in compliance with the recommendations of the national laws in force relating to biomedical research; * Signed written informed consent obtained prior to any study-specific screening procedures Exclusion Criteria: * Rectal tumor operated before inclusion * Symptoms related to the rectal tumor requiring first intention rectal surgery (appreciated by investigator) * Contra-indication for surgery * Resectable metastases * Complicated (obstruction, bleeding, abscess, perforation) primary tumor requiring emergency surgery and/or contra-indicating first line-chemotherapy * Non-resectable primary tumor (with wild margin) * Age \> 75 years \< 18 years * ECOG performance status \> 2 * Under nutrition (albumin \< 30 g/l) * Peritoneal carcinomatosis * Disease progression under chemotherapy (RECIST 1.1 criteria) * Known hypersensitivity reaction or specific contraindications to any of the components of study treatments * Clinically relevant coronary artery disease or history of myocardial infarction in the last 12 months, or high risk of uncontrolled arrhythmia * Pregnancy (absence to be confirmed by ß-hCG test) or breast-feeding; * Previous malignancy in the last 5 years * Medical, geographical, sociological, psychological or legal conditions that would prevent the patient from completing the study or signing the informed consent; in the investigator's opinion * Any significant disease which, in the investigator's opinion, excludes the patient from the study * Under an administrative or legal supervision.