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September 1989

The Resection of Hepatic Metastases: Another View

Author Affiliations

From the Department of Surgery, Mayo Medical School, Rochester, Minn. Reprint requests to Department of Surgery, Mayo Clinic, Rochester, MN 55905 (Dr Adson).

Arch Surg. 1989;124(9):1023-1024. doi:10.1001/archsurg.1989.01410090029005

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