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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): Alsir A.M. Ahmed Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ahmed, A. A.M. Articles by Sarsam, M. A.I. Search for Related Content PubMed Articles by Ahmed, A. A.M. Articles by Sarsam, M. A.I. Related Collections Related Article

Ann Thorac Surg 2002;74:300
© 2002 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Department of Cardiac Surgery, The Royal Victoria Hospital, Grosvenor Rd, Belfast BT12 6BA, Northern Ireland

e-mail: alsir{at}hotmail.com

To the Editor

We appreciate Dr Ibarra-Pérez’s comments on our case report [1]. The purpose of the report was to demonstrate the feasibility and potential benefits of combined lung resection and off-pump coronary artery bypass grafting to left-sided vessels, in this case the marginal branch of the circumflex artery, through a left thoracotomy. This explains the emphasis on the cardiac aspect of the procedure.

We agree with Dr Ibarra-Pérez that systematic lymph node sampling or lymph node resection is an integral part of operations for lung cancer for the purpose of accurate staging, and this is routinely performed at our institution. However, it is important to know that although intraoperative mediastinal lymph node dissection offers the benefit of accurate staging, there is little benefit of therapeutic value. We hope that with advances in adjuvant therapy, the information provided will be more useful. In addition, the procedure is associated with some morbidity; bleeding, chylothorax, and recurrent laryngeal nerve injury have all been reported.

For these reasons, we elected not to perform mediastinal lymph node dissection in this patient. We relied on the findings of the computed tomography scan, which did not show any enlarged lymph nodes, and the intraoperative assessment of the lymph nodes, which has a sensitivity of 71% and a specificity of 94% [2]. We believe the case of this patient is an isolated event, and our actions were a matter of clinical judgment rather than a surgical sin.

References

1. Ahmed A.A.M., Sarsam M.A.I. Off-pump combined coronary artery bypass grafting and left upper lobectomy through left posterolateral thoracotomy. Ann Thorac Surg 2001;71:2016-2018.[Abstract/Free Full Text]
2. Gaer J.A., Goldstraw P. Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus. Eur J Cardio-thorac Surg 1990;4:207-210.[Abstract]

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): Alsir A.M. Ahmed Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ahmed, A. A.M. Articles by Sarsam, M. A.I. Search for Related Content PubMed Articles by Ahmed, A. A.M. Articles by Sarsam, M. A.I. Related Collections Related Article