| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;77:1504
© 2004 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Boston Medical Center, B-402, 88 E Newton St, Boston, MA 02118, USA
e-mail: benedict.daly{at}bmc.org
To the Editor:
Sabawata and colleagues reference their report [1] of a technique to detect malignant cells at the cut margin of wedge resections. Their method appears to be more sensitive than routine histological study. In a series of 15 patients with stage I lung cancer undergoing wedge resection, 7 had positive cytological findings at the margin compared with 3 whose tumor cells were identified on histological section. Four of the 7 patients experienced local recurrence 4 to 12 months after resection. None of the 8 patients with negative cytological results had development of local recurrence during follow-up ranging from 38 to 60 months. Using a different cytological technique, Higashiyama and associates [2] identified tumor cells at the margin of 9 of 105 patients undergoing limited resection for stage I lung cancer. None of the 96 patients with negative cytological margins had local recurrence during a median follow-up of 27 months.
Two of our 29 patients with stage I tumors had tumor recurrence at the margin of resection at 40 and 60 months postoperatively [3]. Both had T1 N0 tumors, and both had negative margins by histological study. Given the timing of these local recurrences, it is clear that seeds can prevent or substantially delay the appearance of local recurrence in most patients undergoing wedge resection for stage I tumors. No complications have been observed that can be attributed to the implantation of the seeds.
As Sabawata and colleagues and Higashiyama and associates have not observed local recurrence in 113 patients with negative cytological margins, it would seem reasonable to continue to study the reliability of these techniques for predicting local recurrence in a larger group of patients. On the other hand, it is difficult to recommend withholding safe therapy that has been shown to prevent or at least substantially delay local recurrence in patients with stage I lung cancer, particularly when limited resection is performed in compromised patients and when a wider margin of resection is not possible.
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 |
