Abstract: There are controversies and consensus in primary tumor resection (PTR) of colorectal cancer with unresec-table metastasis. PTR is required to palliate presenting symptoms. However, it remains controversial whether up-front PTR is effective for asymptomatic primary tumor. Favorers believe that PTR could prevent tumor-related complications such as bleeding,perforation,and bowel obstruction while create favorable conditions for subsequent chemotherapy. Opponents worry that post-operative recovery and complications would delay the timing of systemic chemotherapy thus increasing risk of disease progression. The authors discuss the correlation between presence of primary tumor and bowel complications and whether PTR brings survival benefits, in order to explore the best treatment strategy for stage Ⅳ colorectal cancer with unresectable metastases.