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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 and Serbia.

(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.

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