In search of evidence – PIPAC on the fast lane

Further randomized studies are needed … is arguably the most frequent conclusion of publications in the field of oncological surgery and most of the time also a hopeless prayer. High-level evidence is indeed always welcome. However, it is a tremendous challenge to conduct randomized controlled trials (RCT) in cancer surgery. Heterogeneity of patients and treatments, difficult blinding, and modest sample size are just some out of many methodological shortcomings frequently encountered in surgical RCTs. Moreover, it is difficult to fund RCTs in surgical oncology since there is usually no major industrial support, in contrast to medical oncology. Last but not least, if the available evidence suggests a much worse outcome for the control arm vs. the experimental surgical arm, it can be very challenging or even impossible to recruit enough patients for a randomized trial