Pulmonary metastasectomy: a common practice based on weak evidence
Author: Treasure, Tom1
Source: Annals of The Royal College of Surgeons of England, Volume 89, Number 8, November 2007 , pp. 744-748(5)
Publisher: The Royal College of Surgeons of England
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Abstract:
The resection of secondary metastases from the lungs is a wide-spread surgical practice. Patients are referred from coloproctology teams to thoracic surgeons specifically for this surgery. What is the expected benefit? I have explored the rationale and searched the literature in order to present these patients with a well-informed opinion for their consideration. I find only weak evidence based on uncontrolled retrospective series which have been interpreted as showing a survival benefit. This has been extrapolated to policy and practice that do not stand up to scrutiny. The practice has never been subjected to randomised trial and I will argue that the present evidence is insufficient to justify the uncontrolled use of an intervention with inescapable short-term morbidity, permanent loss of function, and major cost implications. I propose ways in which the evidence may be improved, including a trial in the areas of most uncertainty.Keywords: PULMONARY METASTASECTOMY; BENEFIT ANALYSIS
Document Type: Research article
DOI: 10.1308/003588407X232198
Affiliations: 1: Clinical Operational Research Unit, University College London, London, UK
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