Analysis

Surgical removal of asymptomatic pulmonary metastases: time for better evidence

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f824 (Published 21 February 2013) Cite this as: BMJ 2013;346:f824

Re: Surgical removal of asymptomatic pulmonary metastases: time for better evidence

A patient with asymptomatic pulmonary metastases will no longer be asymptomatic, as the morbidity including pain following excision (even with VATS) is significant. There is also strong evidence from animal models that tumour removal is followed by accelerated growth of metastases(1). In my experience, patient are never informed of this possibility. Surgeons stress the benefits (possible "cure") and underestimate morbidity.

In the absence of evidence, why are asymptomatic metastases excised?

1: Qadri SS, Wang JH, Coffey JC, Alam M, O'Donnell A, Aherne T, Redmond HP. Can
surgery for cancer accelerate the progression of secondary tumors within residual minimal disease at both local and systemic levels? Ann Thorac Surg. 2005
Sep;80(3):1046-50; discussion 1050-1. PubMed PMID: 16122483.

Competing interests: No competing interests
24 February 2013
Harry Rogers
Internal Medicine Physician
Independent
Melbourne Australia 3000
Click to like:
44
Vote down!