Pulmonary metastasectomy in colorectal cancer: a randomized controlled trial

A preprint of pulmonary metastasectomy in colorectal cancer (PulMiCC) was included the meta-analysis patients with by Ratnayake et al.1 The PulMiCC trial published full 93 randomized either to undergo surgical or not. There no crossover from control treatment arm and difference survival (hazard ratio 0.93, 95% confidence interval 0.56–1.56). (Figure 1) Although not significant, median 4-year favoured group over at 3.8 versus 3.5 years, 47% 44%, respectively.2 quality life health utility benefit.3 We are puzzled comment that there ‘an unclear risk selection bias failure report a further detail on participant population’. seven important prognostic factors between two arms, which were well balanced. doubt it is appropriate meaningful include Randomised Controlled Trial non-randomized studies (Ratnayake al.,1 figs 2c,d). Comparisons using data retrospective cohort (as all other nine this appear be) unreliable. They will inevitably be confounded known unknown factors. This obvious Methodological Index for NOn-Randomised Studies scores supplementary table 4), shows six scored 0, three 1, criterion 11 – ‘equivalent baseline characteristics’. findings indicate only large-scale phase III trials can now determine whether any benefit metastasectomy. What clear Society Thoracic Surgeons consensus assumed ‘zero’ 5-year untrue.4 more usual estimate <5% would have been replicated if 2/47 (4.2%) survivors whereas 13/47 (27.6%), P = 0.0036 Fisher's exact test. Fergus Macbeth: Conceptualization; curation; methodology; project administration; supervision; writing-original draft. Norman Williams: Data formal analysis; software; validation; writing-review & editing.