Reply by the Authors of the Original Article

We appreciate the response[1] to our article “Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients.”[2] We read with great interest the recently published results of the prospective observational Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) cohort study involving 512 patients, where the authors observed a 5-year survival rate of 22% in the control group of 128 patients with colorectal lung metastases who did not undergo pulmonary metastasectomy (PM).[3]

Indeed, 22% was much higher than <5% as reported 30 years ago. We suppose that the “better-than-zero” overall survival as well as improved progression-free survival in non-PM patients is a consequence of the better systemic treatment options that have developed over the last decades. However, another reason for this may be the biology of the oligometastatic colorectal cancer (CRC), which, in our opinion, has not been fully understood yet. The fact that in our previously published retrospective cohort of 220 CRC patients who underwent PM over a very long period of >40 years, there was a reasonable long-term survival of even >20 years after pulmonary resection means that the biology of resectable CRC disease must not necessarily be an aggressive one.[4] This would also explain the better-than-expected survival in some patients not undergoing surgery.

As supporters of the theory of oligometastatic disease and therefore of the local therapy concept, we agree with Van Raemdonck and believe that PM may cure patients who would have to continue to live on with metastatic disease.[5]

We reckon that the recently published outcomes of the PulMiCC study do not have enough strength to change our PM practice. However, we appreciate the efforts of the PulMiCC trial authors who over the last decade have consistently tried to find the best scientific evidence on the management of pulmonary metastatic CRC.

Publication History

Received: 03 June 2021

Accepted: 29 June 2021

Article published online:
31 December 2021

• References

• 1 Treasure T, Macbeth F. Pulmonary metastasectomy: association is not causation. Response to Dudek et al. Thorac Cardiovasc Surg 2021
• 2 Dudek W, Schreiner W, Haj Khalaf M, Sirbu H. Surgery for pulmonary metastases: long-term survival in 281 patients. Thorac Cardiovasc Surg 2021; DOI: 10.1055/s-0041-1725203.
• 3 Treasure T, Farewell V, Macbeth F. et al; PulMiCCinvestigators. The Pulmonary Metastasectomy in Colorectal Cancer cohort study: analysis of case selection, risk factors and survival in a prospective observational study of 512 patients. Colorectal Dis 2021; 23 (07) 1793-1803
• 4 Dudek W, Schreiner W, Hohenberger W, Klein P, Sirbu H. Forty-two years' experience with pulmonary resections of metastases from colorectal cancer. Thorac Cardiovasc Surg 2017; 65 (07) 560-566
• 5 Van Raemdonck D, Treasure T, Van Cutsem E, Macbeth F. Pulmonary Metastasectomy in Colorectal Cancer: has the randomized controlled trial brought enough reliable evidence to convince believers in metastasectomy to reconsider their oncological practice?. Eur J Cardiothorac Surg 2021; 59 (03) 517-521