Surgical removal of asymptomatic pulmonary metastases: time for better evidence

First Do No Harm: too often forgotten in modern medicine

24 February 2013

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: None declared

Harry Rogers, Internal Medicine Physician

Independent, Melbourne Australia 3000

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