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Pulmonary metastasectomy: a common practice based on weak evidence.
1Clinical Operational Research Unit, University College London, London, UK. tom.treasure@googlem
Annals of the Royal College of Surgeons of England
|November 15, 2007
Summary
Surgical resection of lung metastases from colorectal cancer lacks strong evidence. Current practice relies on weak retrospective data, not randomized trials, questioning its benefit despite significant patient risks and costs.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Evidence-Based Medicine
Background:
- Resection of secondary lung metastases is common, with patients referred from coloproctology to thoracic surgery.
- The clinical benefit of this widespread surgical practice remains unclear.
Purpose of the Study:
- To explore the rationale and review the literature regarding the benefits of lung metastasectomy for colorectal cancer.
- To critically evaluate the evidence supporting this surgical intervention.
Main Methods:
- Literature search and critical appraisal of existing studies on lung metastasectomy for colorectal cancer.
- Analysis of evidence from uncontrolled retrospective series.
Main Results:
- Evidence supporting survival benefit is weak, primarily from uncontrolled retrospective studies.
- The practice has not been validated by randomized controlled trials.
- Current evidence is insufficient to justify the intervention's morbidity, functional loss, and costs.
Conclusions:
- The current evidence base for lung metastasectomy in colorectal cancer is insufficient.
- The practice warrants re-evaluation due to significant patient morbidity and costs.
- Further research, including randomized trials, is needed to clarify the true benefit.
