Reply to ‘Comment on “The myth of pulmonary metastasectomy’”

We thank Zellweger and Gonzalez for their comments on our article about pulmonary metastasectomy.1 We agree with much of what they say about the need for multidisciplinary management and the importance of ruling out other diagnoses such as primary lung cancer, but we need to correct several misunderstandings. The results of all 93 randomised patients in PulMiCC have now been published in an updated report,2 which confirms the lack of a significant survival difference (hazard ratio (HR) 0.93 (95% confidence interval (CI): 0.56,1.56)) and median survivals of 3.5 and 3.8 years for intervention and control patients, respectively. Although the numbers randomised were small, the trial has sufficient power to make it highly improbable that the 5-year survival rate in unoperated patients is <5%, as is so widely believed.