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Ann Thorac Surg 1996;62:216-217
© 1996 The Society of Thoracic Surgeons

Discussion

Discussion

The first 300 words of the full text of this article appear below.

See also page 213.

DR MICHAEL J. MACK (Dallas, TX): I congratulate Dr McCormack on conducting this pilot study. I also congratulate her on the occasion of her retirement and acknowledge the valuable contributions she has made to the field of thoracic oncology throughout her career. This specialty is more enlightened because of her contributions. I also appreciate her providing me with a manuscript for review before this meeting.

My discussion will focus on two aspects of the presentation: (1) the incisions used and (2) the accuracy of computed tomographic (CT) scanning. As Dr McCormack has alluded to, completeness of resection of all metastatic disease has been said to have positive prognostic significance. Because it is known that up to 45% of patients thought to have unilateral disease by CT scan will in fact have bilateral disease, why then did you not take this concept of complete resection to its logical conclusion and perform a sternotomy or clamshell incision rather than a thoracotomy after video-assisted thoracic surgery (VATS) so that the contralateral lung could also be examined by palpation?

The second point is regarding the sensitivity of CT scanning for detecting metastatic lesions. I agree that because surgeons using VATS for resection lose the ability to palpate manually the lung, one is totally dependent on the accuracy of the preoperative CT scan to detect occult nodules. In Dr McCormack's series 78% of patients had additional lesions detected at thoracotomy not imaged on the preoperative CT scan. Unfortunately, 16 of the 18 patients had CT scans performed on old generation scanners rather than on spiral or ultrafast CT scans. In our experience with the newer scans, the problem is not a lack of sensitivity but rather too much sensitivity resulting in detection of nodules as small as 2 mm.

A 2-mm . . . [Full Text of this Article]


Related Article

Role of Video-Assisted Thoracic Surgery in the Treatment of Pulmonary Metastases: Results of a Prospective Trial
Patricia M. McCormack, Manjit S. Bains, Colin B. Begg, Michael E. Burt, Robert J. Downey, David M. Panicek, Valerie W. Rusch, Maureen Zakowski, and Robert J. Ginsberg
Ann. Thorac. Surg. 1996 62: 213-216. [Abstract] [Full Text]





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Copyright © 1996 by The Society of Thoracic Surgeons.