I am sympathetic with Dr Silen's1 concern about the indications for resection of hepatic metastases, because I have been guided by such reservations for 30 years. However, I do not accept his condemnation of beliefs that have been acquired cautiously and rationally throughout these years. I think there is some validity where he has found none, and I am convinced that some people who have hepatic metastases will live much longer if their liver lesions are removed. There is a small, well-defined group of patients who must not be assigned to therapeutic trials that would deny half of them their only chance for extended survival. Thus, we have a difference of opinion that at first seems to be absolute. Nevertheless, I think that something good can come from an examination of this disagreement.
The uncertainties that we share relate to the nature of controls, the differences between total populations
Adson MA. The Resection of Hepatic MetastasesAnother View. Arch Surg. 1989;124(9):1023-1024. doi:10.1001/archsurg.1989.01410090029005