The JAMA newsletter reports on research aimed at improving the critical care and treatment of multiorgan metastatic colorectal cancer (mCRC). Derek C. Angus presents 5 big ideas to improve care for critically ill patients. The ORCHESTRA study investigated the effectiveness of tumor removal (debulking) in combination with chemotherapy in the treatment of multiorgan m CRC. The results of this randomized clinical trial are analyzed in the original research and accompanying editorial. The ORCHESTRA study suggests that debulking in metastatic colorectal cancer may not always be beneficial.