If no difference in effectiveness is found between two treatments it may be because the treatments are similarly ineffective

The authors are to be congratulated for undertaking a systematic review and meta-analysis partly following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) checklist. It is only by working to internationally agreed standards can surgeons expect to gain scientific credibility for their treatments. The E in EBM stands for evidence, not for eminence, experience, expertise, eloquence or any of the other “E” words that have previously been used to provide authority for the practice of surgery for advanced and metastatic cancer. Systematic reviewing should be an essential component of the appraisal of any clinical practice: we need to know what is already known before embarking on further studies.