| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;72:322
© 2001 The Society of Thoracic Surgeons
e-mail: kaseda{at}ra2.so-net.ne.jp
To the Editor
We have read with interest the response by Dr Dunton to our article. He mentioned that our report comes from "only personal experience of several routine cases." However, numerous publications are in agreement with our conclusion that pulmonary function tests are better after VATS than thoracotomy [1].
Furthermore, many surgeons [2–5] have reported improved survival after using VATS. Walker [2] reported reasons for better survival after VATS. It is not "magical thinking" but rather "an early, valid evolution of scientific fact."
If you read the statistical literature on the validity of prospective randomized trials in surgery, you find many contradictions. There are many legal, moral, and ethical problems that affect these studies. These studies can never be double blind; surrogate surgeons (residents in training) often perform the operation. The experience and surgical skills vary among different surgeons. In multi-institutional studies, each institution must do the same number of operations in each group. More cases from one institution or one surgeon will bias the study. Many published randomized trials do not follow objective, logical rules for drawing conclusions, and so are invalid. For example, the same randomized trial refers repeatedly to the same surgical group, although the group’s results are different and contradictory. Very important effects of biological activity of the tumor and micrometastasis are not considered in random trials. Surgeons are biased and will not perform certain operations because of lack of knowledge, lack of skill, and inadequate training.
Furthermore, random trials should never be performed during the evolution of a surgical technique, because there will be too much bias, variation of skills, learning curve, and so on.
Some statisticians recommend omitting randomized trials and reporting only what was done. If the journals do not publish retrospective work, there would be nothing to publish and no journals.
Those of us who have done thousands of thoracotomies and thousands of VATS have proved that VATS is far superior in yielding less pain, shorter hospitalization, quicker recovery, less blood loss, less infection, less surgical mortality and morbidity, and a better 5-year survival for cancer.
The VATS technique is improving day by day as an alternative to old-fashioned thoracotomy. Therefore, a "status quo" surgeon will fall farther and farther behind the innovative surgeons who are eager to promote VATS technique.
References
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
