Metastasectomy for colorectal cancer: are there clothes on the emperor?

摘要

The resection of liver and lung metastases in colorectal cancer became adopted into practice by the end of the 1990s. Belief in the clinical effectiveness of liver metastasectomy is strongly held to the extent that a group of liver surgeons in the Netherlands state ‘On ethical grounds, a true randomised trial comparing both treatment strategies [that is surgical resection or not] in patients with resectable colorectal liver metastases has not been, and will not be performed’. This view is shared by their colleagues internationally. However, we know from a recent meta-analysis of a succession of randomised controlled trials that when asymptomatic metastases are detected sooner, so that more people can be operated on, there has been no discernible survival benefit ( ). We also know from a recent meta-analysis that systemic treatments for metastatic colorectal cancer have been rigorously tested in randomised controlled trials but that an effect on survival attributable to metastasectomy remains unproven and open to doubt. A trial of pulmonary metastasectomy in colorectal cancer is currently being analysed. I will argue in this commentary for an equivalent trial to be undertaken for liver metastasectomy.