National variation in pulmonary metastasectomy for colorectal cancer

Abstract

Colorectal cancer is the fourth most common cancer in the UK, with around 42 000 new cases per year, and the second leading cause of cancer-related death [1]. Approximately 20% of colorectal cancer patients will have metastases at diagnosis and they will subsequently become apparent in up to 50% of people [2]. Around 5%-15% of patients with cancer of the colon will develop metastases in the lungs during the disease course, and such spread is proportionally more common in rectal cancer patients, because of the difference

The Pulmonary Metastasectomy in Colorectal Cancer cohort study: Analysis of case selection, risk factors and survival in a prospective observational study of 512 patients

“…The big data study in the English NHS already referred to showed that lung metastasectomy is highly selective, being used on only 2.3% of patients with resected CRC in 2013 [ 10 ]. A study in the Korean National Health Insurance Database of 2573 CRC lung metastasectomy patients found a similar rate of 2.5% [ 24 ].…”

“…Colorectal Disease has recently published a big data study of pulmonary metastasectomy for CRC [ 10 ]. Among 173 354 patients who had a CRC resection from 2005 to 2013, lung resection was subsequently reported in 3434 patients which averages 2% over the time span of the study.…”

Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial

“…Big databases include all patients with metastatic disease, rather than the 2% to 3% selected for metastasectomy. 21,22 Furthermore, Big Data misses prognostic factors-most of the known and all the unknown-so however big the collection of data, conclusions are less reliable than a careful RCT. Databases of cancer treatments record therapeutic events.…”

The evidence for surgical interventions: Lung metastasectomy outcomes in the PulMiCC trial, an observational cohort study, and big data analysis

“…While randomization was constrained by powerful influences, the observational cohort thrived [2,4]. With the addition of big data research, the general ineffectiveness of piecemeal removal of blood-borne metastases is becoming evident [3,5]. Why does Basingstoke not use its resource of a large clinic base and highly respected leadership to lead on bigger, better and focused trials of peritoneal disease, thus challenging falsehood with evidence?…”

“…Five‐year survival was commensurately better. Only a small minority of patients have lung metastasectomy, indicating a high degree of selectivity [3]. In the PulMiCC controlled trial there was excellent balance between the arms and there was no survival difference at any time point [4].…”