Surgery and ablative techniques for lung metastases in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial: is there equivalence?

The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial relies on a state of equipoise about any survival advantage from the treatment of lung metastases (1,2). It is accepted by the trialists that there may be rare instances when a lung metastasis is truly the only residual disease after treatment of the primary cancer and that its removal or ablation results in cure. Much more often the lung metastasis is the most readily visible manifestation of generalised blood borne dissemination and that becomes evident in the course of time. Most patient who have had lung metastasectomy go on to die of their cancer, even if they have survived the first 5 years.