Pulmonary metastasectomy for colorectal cancer: weak evidence and no randomised trials

The practice of pulmonary metastasectomy is widespread. A web-based survey run as part of the ESTS Working Group on pulmonary metastasectomy has provided some insights into similarities and variations in belief and practice [Internullo E, Cassivi S, Van Raemdonck D, Friedel G, Treasure T. Pulmonary metastasectomy: the state of the practice in Europe. Interact Cardiovasc Thorac Surg 2007;6(Suppl. 2):S182. Ref Type: Abstract.]. What we do know from the work of the group and from a systematic review [Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg 2007;84(July(1)):324-38.] is that there are no randomised outcome data to guide us. We rely on presumed benefit based on comparison with poorly characterised survival estimates for other patients with advanced disease. In this review I consider the evidence to date and conclude that a trial is needed.