The majority of asymptomatic patients with stage IV colon cancer do not benefit from upfront surgery and should be initially treated with chemotherapy. This retrospective series contributed to change the culture associated with the management of these patients and was subsequently corroborated by larger prospective studies. Most patients treated with modern chemotherapy do not achieve cure but are adequately palliated until their inevitable demise. Selected patients experience substantial treatment response which can make them eligible for subsequent surgery with curative intent. Surgery to address treatment-related or tumor-related complications is rare.