- Save the Children launch website designed with CORU's help
- Attempts at surgical removal are of no benefit to asbestos cancer sufferers finds trial led by CORU's Tom Treasure
- CORU's work shows effects of selective citation on surgical practice
- Pandemic flu countermeasure work published in Vaccine
- Editorial praises CORU's simple risk stratification model
- Tom Treasure's talk is ranked among top three presentations
- The Ekjut trial in India is selected as Trial of the Year!
- Christos Vasilakis gives keynote lecture at Young OR 17 conference
- CORU informs national policy on pandemic flu
- CORU work examines the foundations of triage
- Christina Pagel gives invited talk at RCM conference
- Martin Utley gives invited talk at the MASHNET workshop
- Making sense of statistics
- UCL helps engineer to heal his own heart
- Christina Pagel has paper published in The Lancet
- Martin Utley promoted to professor
- Professor Tom Treasure attends NICE International conference
- Citation for Steve Gallivan
- NCEPOD report highlights concerns over chemotherapy
- CORU 25 year celebration
- Marfan aortic aneurysm: Golesworthy wins Healthcare Award
- CORU projections of skilled birth attendance rates in world's poorest regions published
- CORU's Skilled Birth Attendance paper is a BMC Highly Accessed paper!
- CORU's visual outcome monitoring tool (VLAD) goes global!
- Number of people living with cancer set to increase significantly
- CORU article highlights challenges in implementing modelling toolkits
- Health financing website receives positive feedback!
- Is surgery to remove secondary cancer always a good thing?
- Sonya Crowe awarded Improvement Science Fellowship by the Health Foundation!
- CORU work helps child heart teams get clearer picture of their results
- CORU's work with the Department of Health's health protection team continues
- UCL Partners successful in bid to host a new £9 million CLAHRC!
- Funding bid to understand complications following children's heart surgery successful!
- Editorial published in Heart discussing the benefits and risks of monitoring mortality
- Health research partnership launches to tackle major health challenges
- CORU's Tom Treasure discusses colorectal cancer in the BMJ
Is surgery to remove secondary cancer always a good thing?
22 February 2013
In this week’s BMJ (1), Tom Treasure and Martin Utley of UCL’s Clinical Operational Research Unit challenge the utility of repeated surgery for sarcoma which became accepted practice 40 years ago. Sarcoma is the name given to cancers of the structural tissues of the body (bone, muscle, fat) as opposed to organs (breast, lung, prostate). Sarcoma, particularly of bone, tends to affect younger people and if it spreads it tends to be by blood borne seeding in the lungs where the nodules of secondary cancer are called metastases. They can be removed by surgery - an operation called metastasectomy.
This has become established practice. Some patients have operation after operation over a number of years but the cancer nearly always comes back. It is debatable if it is ever cured by these operations. An analysis of all the published evidence has shown no evidence that this surgery improves survival or quality of life (2). There may be an impression that the surgery is worthwhile because only those with inherently slowly progressing disease are sent back for surgery. In the article in The British Medical Journal the authors call for a randomised trial.
The authors first brought their doubt about the benefit of
metastasectomy for cancer in general to attention in the BMJ in 2007 (3). A randomised trial of pulmonary
metastasectomy in much commoner bowel cancer is being undertaken in UK, Italy
(1) Treasure T, Utley M. Surgical removal of asymptomatic pulmonary metastases: time for better evidence. BMJ 2013, 346:f824
(2) Treasure T, Fiorentino F, Scarci M, Moller H, Utley M. Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2012;2(5):doi 10.1136 bmjopen-2012-00736.
(3) Treasure T, Utley M, Hunt I. When professional opinion is not enough: surgical resection of pulmonary metastases. BMJ 2007 April 21;334(7598):831-2.