Colorectal cancer metastases: evaluate current practice before introducing the “next new thing”

The story of colorectal cancer metastasectomy does not end with Treasure and colleagues' fascinating tale. 1 A recent randomised trial looked at the usefulness of positron emission tomography-computed tomography (PET-CT) for identifying suitable candidates for colorectal cancer liver metastasis surgery. 2 Unlike an earlier trial, which had profound weaknesses, it found no evidence of benefit from PET-CT. 3 4 Both trials investigated whether patients could be spared unnecessary surgery because of unresectable metastatic spread identified by PET-CT. [...]intensive carcinoembryonic antigen (or CT) screening in colorectal cancer follow-up is used to detect recurrence as early as possible, then an aggressive surgical approach is pursued, and afterwards additional advanced diagnostic imaging (PET-CT) is used to exclude patients from surgery again.