HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Keagy, B. A. Articles by Wilcox, B. R. Search for Related Content PubMed PubMed Citation Articles by Keagy, B. A. Articles by Wilcox, B. R.

The Annals of Thoracic Surgery, Vol 38, 314-316, Copyright © 1984 by The Society of Thoracic Surgeons

ARTICLES

Major pulmonary resection for suspected but unconfirmed malignancy

BA Keagy, PJ Starek, GF Murray, JW Battaglini, ME Lores and BR Wilcox

Thoracotomy is not infrequently performed in patients with suspected pulmonary carcinoma but with no histological or cytological confirmation of malignancy. The intraoperative decision to proceed with major pulmonary resection (lobectomy or pneumonectomy) is difficult if a large or central lesion precludes total excisional biopsy. Incisional or needle biopsies violate the principles of good cancer surgery, and the results may be inconclusive if the tumor is missed and areas of associated inflammation or necrosis are sampled. Between January 1, 1970, and December 31, 1980, 303 patients underwent thoracotomy for suspected but unconfirmed malignancy. One hundred twenty-two had a minor resection only, 79 had a major resection (lobectomy or pneumonectomy) after a diagnosis was established by frozen section, and 102 had a major resection without a definitive diagnosis of cancer. Carcinoma subsequently was found in 68% (69) of this group of 102 patients, and benign lesions were identified in the remaining 32% (33), all of whom underwent lobectomy. The diagnoses in these 33 patients included seven granulomas, three hamartomas, nine instances of tuberculosis, and fourteen instances of fibrosis, inflammation, or cystic degeneration. The 2 thirty-day operative deaths in this group of 102 patients occurred among the 69 with malignant disease; 1 died of hemorrhage following pneumonectomy and 1, of respiratory insufficiency after lobectomy. In all 303 patients, there was no difference in operative mortality (p less than 0.01) between lobectomy (2%) and a lesser resection (1.6%). In a patient with a suspicious but inaccessible pulmonary lesion, lobectomy can be performed safely without violating the principles of cancer surgery. This recommendation should probably not be extended to lesions requiring pneumonectomy, because of the increased rates of morbidity and mortality associated with that procedure.

This article has been cited by other articles:

				Y. J. Jeong, K. S. Lee, S. Y. Jeong, M. J. Chung, S. S. Shim, H. Kim, O J. Kwon, and S. Kim Solitary Pulmonary Nodule: Characterization with Combined Wash-in and Washout Features at Dynamic Multi-Detector Row CT Radiology, November 1, 2005; 237(2): 675 - 683. [Abstract] [Full Text] [PDF]

				S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, S. J. Mandrekar, S. L. Hillman, A.-M. Sykes, G. L. Aughenbaugh, A. O. Bungum, and K. L. Allen CT Screening for Lung Cancer: Five-year Prospective Experience Radiology, April 1, 2005; 235(1): 259 - 265. [Abstract] [Full Text] [PDF]

				B. Mahesh, C. Forrester-Wood, A. Yunus, R. Ahsan, K. Amer, A. Morgan, and R. Ascione Value of wide-margin wedge resection for solitary pulmonary nodule: a single center experience Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 474 - 479. [Abstract] [Full Text] [PDF]

				S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, J. A. Sloan, A.-M. Sykes, G. L. Aughenbaugh, and M. A. Clemens Lung Cancer Screening with CT: Mayo Clinic Experience Radiology, March 1, 2003; 226(3): 756 - 761. [Abstract] [Full Text] [PDF]

				S. J. SWENSEN, J. R. JETT, J. A. SLOAN, D. E. MIDTHUN, T. E. HARTMAN, A.-M. SYKES, G. L. AUGHENBAUGH, F. E. ZINK, S. L. HILLMAN, G. R. NOETZEL, et al. Screening for Lung Cancer with Low-Dose Spiral Computed Tomography Am. J. Respir. Crit. Care Med., February 15, 2002; 165(4): 508 - 513. [Abstract] [Full Text] [PDF]

				J. Furak, I. Trojan, T. Szoke, L. Tiszlavicz, Z. Morvay, E. Csada, and A. Balogh Surgical intervention for pulmonary tuberculosis: analysis of indications and perioperative data relating to diagnostic and therapeutic resections Eur. J. Cardiothorac. Surg., October 1, 2001; 20(4): 722 - 727. [Abstract] [Full Text] [PDF]

				S. J. Swensen Functional CT: Lung Nodule Evaluation RadioGraphics, July 1, 2000; 20(4): 1178 - 1181. [Full Text] [PDF]

				K. Nakamura, H. Yoshida, R. Engelmann, H. MacMahon, S. Katsuragawa, T. Ishida, K. Ashizawa, and K. Doi Computerized Analysis of the Likelihood of Malignancy in Solitary Pulmonary Nodules with Use of Artificial Neural Networks Radiology, March 1, 2000; 214(3): 823 - 830. [Abstract] [Full Text]

				S. J. Swensen, R. W. Viggiano, D. E. Midthun, N. L. Müller, A. Sherrick, K. Yamashita, D. P. Naidich, E. F. Patz, T. E. Hartman, J. R. Muhm, et al. Lung Nodule Enhancement at CT: Multicenter Study1 Radiology, January 1, 2000; 214(1): 73 - 80. [Abstract] [Full Text]

				S. J. Swensen, K. Yamashita, C. H. McCollough, R. W. Viggiano, D. E. Midthun, E. F. Patz Jr, J. R. Muhm, and A. L. Weaver Lung Nodules: Dual-Kilovolt Peak Analysis with CT-Multicenter Study1 Radiology, January 1, 2000; 214(1): 81 - 85. [Abstract] [Full Text]

				J. R. Izbicki, W. T. Knoefel, B. Passlick, M. Habekost, O. Karg, and O. Thetter RISK ANALYSIS AND LONG-TERM SURVIVAL IN PATIENTS UNDERGOING EXTENDED RESECTION OF LOCALLY ADVANCED LUNG CANCER J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 386 - 395. [Abstract] [Full Text]

				H.K. Huang, D. R. Aberle, R. Lufkin, E. G. Grant, W. N. Hanafee, and H. Kangarloo Advances in Medical Imaging Ann Intern Med, February 1, 1990; 112(3): 203 - 220. [Abstract] [PDF]