Ann Thorac Surg 2000;69:1257
© 2000 The Society of Thoracic Surgeons
John R. Benfield, MDa
a 11611 Terryhill Pl, Los Angeles, CA 90049, USA
Tumor transplantation is a well-established laboratory research technique. Circulating cancer cells can often be demonstrated during the intraoperative handling of neoplasms. It is surprising that the incidence of incisional metastases after mediastinoscopy is only about 0.12%, and it is astonishing that perceptible cancer implants are rare after percutaneous needle biopsies. Patients with aggressive cancers can be dying of systemic disease before the incisional growths become apparent, and patients who escape incisional metastases probably have cancers that are more benign in behavior as well as better local biological defense mechanisms.
The patient in this report had a 6-cm T3 N0 large cell undifferentiated cancer with mediastinal fat infiltration. This was a locally aggressive cancer, and the patient was a strong candidate for the incisional metastases that occurred. We do not know how to prevent this type of spread.
After studying the cases of 5 other patients with incisional metastases after mediastinoscopy, Al-Sofyani and coauthors conclude "that neither the pathologic cell type... nor the degree of cellular differentiation has any relationship to the development of cervical mediastinoscopy incisional metastasis." This reflects the limitations of current methods for determining the biological behavior of cancers and the paucity of ways to measure host defense mechanisms. Retrospective studies of morphology, staging, and the usual clinical data have reached their limits. Continuing progress in basic science portends that eventually each cancer will be studied with molecular biological methods and patients resistance to metastases will be evaluated. Such information should permit estimation of the anticipated biological behavior of cancers at the outset of treatment. Had such methods been available for the patient in this report, the finding of cancer in the mediastinal fat and the propensity of this neoplasm to cause incisional metastases might have been predictable and perhaps even preventable.
Cervical mediastinoscopy incisional metastasis
- Medhat Al-Sofyani, Donna E. Maziak, and Farid M. Shamji
Ann. Thorac. Surg. 2000 69: 1255-1257.