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Ann Thorac Surg 1999;67:1541
© 1999 The Society of Thoracic Surgeons

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Correspondence

Reply

^a General Thoracic Surgery, Hyogo Medical Center, 13-70 Kitaoji Akashi, Hyogo, Japan 673-8558

e-mail: n-tsubo{at}sanynet.ne.jp

To the Editor

I appreciate the comments of Dr Lewis and coworkers concerning our article on extended segmentectomy to remove tumors smaller than 2 cm. I have very much enjoyed every line of it, which reminded me of a pleasant discussion I had with Dr Lewis during breakfast at a hotel in Tokyo. As Dr Lewis mentioned, a lesser resection and less trauma might provide more benefit to patients after all. In the past 13 years, we have performed pneumonectomy in only 63 of the 1,121 patients (5%) we have treated for lung cancer. This conservative policy did not affect the survival of patients who underwent a type of bilobectomy or complex bronchoplasty to avoid pneumonectomy [1]. Concerning lymph node dissection, we proposed rational and reasonable dissection according to the tumor location and the adjacent findings [2].

A new group study, in which upper segmentectomy or lingulectomy is performed to remove T1 tumors located in the left upper lobe in patients who can tolerate a lobectomy, has started. We hope the results will be reported and the procedure will become common. At present, thoracic surgeons are fully aware that left upper lobectomy is too much resection and is one of the procedures most frequently associated with postoperative complications.

Please try the technique I have described, if the opportunity arises. The method will allow any thoracic surgeon to know more clearly and quickly where the intersegmental line is. Although we have just started to understand that cure depends more on the biology of the tumor than on the technique, let me continue using this more complex procedure for a while, compared with simultaneously stapled lobectomy [3].

References

1. Tsubota N., Yoshimura M., Murotani A., Miyamoto Y., Matoba Y. One hundred one cases of bronchoplasty for primary lung cancer. Surg Today 1994;24:978-981.[Medline]
2. Okada M., Tsubota N., Yoshimura M., Miyamoto Y., Yamagishi H., Satake S. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinoma: role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg 1998;116:949-963.[Abstract/Free Full Text]
3. Lewis R.J., Caccavale R.J., Sisler G.E., Bocage J.P., Mackenzie J.W. One hundred video-assisted thoracic surgical simultaneously stapled lobectomies without rib spreading. Ann Thorac Surg 1997;63:1415-1422.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Noriaki Tsubota Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tsubota, N. Search for Related Content PubMed Articles by Tsubota, N. Related Collections Related Article