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Ann Thorac Surg 2001;71:433-434
© 2001 The Society of Thoracic Surgeons

Invited commentary

Gerard A. Silvestri, MD, MSa

a Division of Pulmonary and Critical Care Medicine, Room 812-CSB, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425, USA

e-mail: silvestri@musc.edu

Two scenarios continue to haunt thoracic surgeons and their patients who are candidates to undergo operation for lung cancer. In the first, a patient with lung cancer, after a thorough history, physical examination, routine laboratory work, and pulmonary function tests, undergoes surgical intervention with curative intent. Two months later, the patient is seen with headache, and brain metastases are found on computed tomography scan. Presumably, the "curative" operation would not have been done had the patient undergone additional extrathoracic staging such as head computed tomography, bone scan, and abdominal computed tomography.

In the second scenario, additional extrathoracic staging is performed "routinely" despite normal results of the clinical evaluation. One of the studies reveals an abnormality that requires further evaluation before consideration of surgical intervention. This can lead to unnecessary and invasive testing with considerable risk. Additional testing can delay operation; in one study [1], the mean time from diagnosis to thoracotomy was 109 days. Further, the waiting period between diagnosis of cancer and definitive treatment is perhaps the most psychologically stressful period of a patient’s . . . [Full Text of this Article]


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Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer
Ann. Thorac. Surg. 2001 71: 425-433. [Abstract] [Full Text] [PDF]



This article has been cited by other articles:


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 Am. J. Respir. Crit. Care Med.Home page
S. G. Spiro and J. C. Porter
Lung Cancer--Where Are We Today?: Current Advances in Staging and Nonsurgical Treatment
Am. J. Respir. Crit. Care Med., November 1, 2002; 166(9): 1166 - 1196.
[Abstract] [Full Text] [PDF]


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