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Ann Thorac Surg 1999;68:309-315
© 1999 The Society of Thoracic Surgeons

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Original Articles

Surgeons’ assessment of symptoms suggesting extrathoracic metastases in patients with lung cancer^*

^a Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, Hamilton, Canada
^b Department of Surgery, McMaster University Health Sciences Center, Hamilton, Canada
^c Department of Surgery, University of Toronto, Toronto, Canada
^d Department of Surgery, Dalhousie University, Halifax, Canada
^e Department of Surgery, University of Western Ontario, London, Canada
^f Department of Surgery, University of British Columbia, Vancouver, Canada
^g Department of Thoracic Surgery, Laval University, Quebec City, Canada

Address reprint requests to Dr Guyatt, Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Center, Room 2C12, 1200 Main St West, Hamilton, ON L8N 3Z5, Canada

Background. In patients with apparently operable non-small cell lung cancer (NSCLC), clinicians often omit investigation for M disease in asymptomatic patients. Previous investigations have not specified in detail what is meant by "symptomatic," and this could differ between surgeons. We have investigated the extent to which surgeons’ criteria differ for presence of symptoms.

Methods. Participating surgeons from seven centers, enrolled patients they judged "asymptomatic" in a randomized trial of investigational strategies for NSCLC. Patients completed a structured questionnaire describing symptoms of the central nervous system (CNS). In 685 patients, we documented CNS symptom recurrence after resectional surgery over 1 year of follow-up.

Results. Two centers enrolled only patients without even the mildest symptoms. Three centers took an intermediate approach, occasionally classifying patients with mild symptoms as "asymptomatic" and thus enrolling them in the trial. Two centers classified an appreciable number of patients with minimal symptoms, and occasionally with more than minimal symptoms, as "asymptomatic." Patients with even mild CNS symptoms were more likely to subsequently present with CNS metastases.

Conclusions. Thoracic surgeons differ in their ideas of what may constitute the symptoms of M disease. Patients with structured questionnaire results that suggest symptoms of CNS disease are more likely to have CNS symptom recurrence after resectional surgery.

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