Aberg, T;
Treasure, T;
(2016)
Analysis of pulmonary metastasis as an indication for operation: an evidence-based approach.
European Journal of Cardio-Thoracic Surgery
, 50
(5)
pp. 792-798.
10.1093/ejcts/ezw140.
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Abstract
Pulmonary metastasectomy is analysed in this paper according to the rules of evidence-based medicine (EBM). Our knowledge of metastasectomy lacks several crucial factors necessary for the tenets of EBM: survival without surgery in this special group of patients; knowledge of the denominator from which the cases are selected; and the biological nature of the individual tumour. If metastasectomy were introduced today as a new treatment, it would not be accepted. Our analysis provides an alternative interpretation of 5-year survival rates of 40% after metastasectomy as being a result of selection of the patients at the benign end of the continuous spectrum of malignancies. It is therefore a statistical illusion. Given the many variables and the long-time course in many patients with or without metastasectomy, the effect of surgery can only be resolved by a randomized control two-armed trial, where the outcomes between an unoperated group (the natural history) and an operated group (the natural history modified by treatment) are compared. Absence of knowledge is readily accepted by many patients if candidly and respectfully explained and so a randomized trial is possible, appropriate and acceptable to a sufficient number of patients. To shed light on whether there is truly a survival benefit from metastasectomy, a randomized trial has been started. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) has so far recruited 86 randomized patients and is open internationally. It is funded for a further 5 years. Interested groups are invited to join the trial.
Type: | Article |
---|---|
Title: | Analysis of pulmonary metastasis as an indication for operation: an evidence-based approach |
Open access status: | An open access version is available from UCL Discovery |
DOI: | 10.1093/ejcts/ezw140 |
Publisher version: | https://doi.org/10.1093/ejcts/ezw140 |
Language: | English |
Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
Keywords: | Evidence-based medicine, Pulmonary metastasectomy |
UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Mathematics UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Mathematics > Clinical Operational Research Unit |
URI: | https://discovery.ucl.ac.uk/id/eprint/10127397 |
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