| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;78:1887-1888
© 2004 The Society of Thoracic Surgeons
Sezione di Chirurgia Generale, Departimento di Scienze Chirurgiche, Radiologiche e Anestesiologiche, Universita di Ferrara, C. so Giovecca 203, 44100 Ferrara, Italy
sors{at}libero.it
To the Editor:
We congratulate Gharagozloo and associates [1] on their well-performed study involving a large series of patients. Anatomical pulmonary resections can be performed through either a thoracotomy or a thoracoscopy with no differences in survival rates and recurrence rates [1, 2]. This study along with others [3, 4] establishes pulmonary lobectomy as the best surgical therapy for early-stage non–small cell lung cancer (NSCLC).
We agree with the authors that anatomical resection is best for T2 N0 M0 pulmonary lesions, but we have some concern about lobectomy for T1 N0 M0 lesions and for NSCLCs less than 1 cm in diameter. In fact, several studies [5–7] show that intentionally limited resections (ie, wedge resection, segmentectomy) result in the same survival rate as lobectomy. Furthermore, these studies demonstrate that the size and the biology of the tumor are important factors to consider in determining the surgical approach. Two other important factors are patient age and health status. We recommend that elderly patients with pulmonary lesions less than 1 cm in diameter undergo intentionally limited resections, as these resections offer the same results as lobectomy. In addition, elderly patients who receive a limited pulmonary resection have lower non-cancer-related death rates than those undergoing lobectomy [5, 6]. Pulmonary wedge resection and segmentectomy in elderly patients carry a higher recurrence rate than lobectomy, but no difference in survival rate has been found [5, 6].
We [8] recommend a limited pulmonary resection with frozen section rather than lobectomy in patients with a radiological diagnosis of malignancy without preoperative histological confirmation. Our preferred approach is to perform a wedge resection with sentinal node biopsy and frozen section and subsequently lobectomy with mediastinal lymphadenectomy in patients with positive pathological findings. As far as mediastinal lymhpadenectomy is concerned, we recommend sentinal node biopsy for lesions without a preoperative histological diagnosis of cancer. Several studies [1, 9, 10] have shown that patients with preoperative T1 N0 M0 lesions can have N2 or N3 disease after resection; thus the decision to perform mediastinal lymphadenectomy should be guided by sentinal node biopsy.
In conclusion, several factors determinate whether conservative or standard anatomical resection for NSCLC should be used. We recommend the less invasive approach as the first therapeutic step and pursue invasive therapy only after obtaining clinical and histological evidence of malignancy.
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 |
