https://orcid.org/0000-0001-9358-7610
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Tom Treasure, Fergus Macbeth, Lesley Fallowfield, A prospective multicentre cohort study of colorectal lung metastasectomy with a nested randomized controlled trial: the key points from the pulmonary metastasectomy in colorectal cancer study, European Journal of Cardio-Thoracic Surgery, Volume 65, Issue 6, June 2024, ezae216, https://doi.org/10.1093/ejcts/ezae216
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Extract
We were interested to read the large retrospective analysis of the results of pulmonary metastasectomy from 15 European thoracic surgical centres [1]. The authors refer to a ‘much debated’ randomized controlled trial (RCT) which ‘disclosed no survival benefit of PM over non-surgical treatment’ and cite the PulMiCC trial (pulmonary metastasectomy in colorectal cancer) [2]. In their detailed analysis of 1647 patients over nearly a decade, more than half had colorectal cancer (CRC) and so PulMiCC is directly relevant. We thank the authors for referencing our work and are pleased to take the opportunity to summarize its findings (Fig. 1) and to comment on their significance with respect to the multicentre retrospective analysis of pulmonary metastasectomy.
The idea of a trial of to test the clinical effectiveness of lung metastasectomy was formally proposed during the launch of the Lung Metastasectomy Project at the 2006 European Society of Thoracic Surgeons annual meeting [3]. There were already many retrospective analyses [4], and there have been many more since [5], none with contemporaneous controls showing the survival rate for similar patients who did not have their metastases resected. To capture this information the PulMiCC study was designed with 2 distinct phases. Patients who had their primary colorectal cancer resected, and were potential candidates for lung metastasectomy, were recruited from 2010 to 2017 in 25 clinical sites, after written informed consent. Of 512 volunteers, 93 agreed to randomization and 28 had non-CRC nodules, leaving an observational cohort of 391. Their survival is depicted in the upper panel of the figure. Using the same selection factors as were available internationally, teams elected to operate on 263 of them. Their survival (upper curve) is similar to the retrospective multicentre analysis [1]. The PulMiCC elective cohort also shows the survival of patients who did not have metastasectomy (red line). Note that the consensus assumption of the American Society of Thoracic Surgeons—that survival was probably nil without operation [5]—was disproved.
