Surgical removal of asymptomatic pulmonary metastases: time for better evidenceBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f824 (Published 21 February 2013) Cite this as: BMJ 2013;346:f824
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While I was interested in the body of this analysis, I take issue with the photograph in the print version ''surgeons operate to remove part of a diseased lung.' While it undoubtedly represents a surgical theatre, and possibly cardiothoracic surgery ( viz the lung retractor in the foreground) surely you could have found a more contemporary image? The one in portrays many archaic features, namely fabric reusable gowns, an autoclave in the background, as well as shelves piled high with equipment gathering dust. I suggest use of this archived photo was just lazy journalism!
Competing interests: HB has a keen interest in the history of medicine and surgery
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