Ann Thorac Surg 2005;80:790
© 2005 The Society of Thoracic Surgeons
Correspondence
Is Identification of Prognostic Factors for Lung Metastasectomy Sufficient to Establish Selection Criteria?
C.S. Pramesh, MS, FRCS,
Rajesh C. Mistry, MS,
Vivek V. Upasani, MS
Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India
(Email: cspramesh{at}vsnl.net).
To the Editor:
We read with interest Inoue and colleagues’ [1] article on identifying prognostic factors for lung metastasectomy for colorectal metastases. Although a retrospective study, the impressive follow-up (mean, 85.9 months) and negligible loss to follow-up (7 of 128 patients) make the study a valuable contribution to the subject. The authors identify bilaterality of tumors, Dukes’ staging of the primary tumor, and synchronicity of lung and hepatic metastases as poor prognostic factors. However, we are puzzled that the authors recommend that metastasectomy not be done in patients with these (relatively) poor prognostic factors. Their own data show 5-year survivals of 27.5% for patients with a high carcinoembryonic antigen, 19.3% for patients with intrathoracic positive lymph nodes, and 38.1%, 31.9%, and 27.8% for Dukes stage B, C, and D, respectively. These are admittedly worse than the "favorable" cohort of patients with a normal carcinoembryonic antigen, negative node, and Dukes stage A. However these survivals are much higher than what would be expected if they were offered no treatment. Although the identification of poor prognostic factors may help decide against surgery in an otherwise borderline patient (eg, with compromised cardiorespiratory function), they should not by themselves be considered contraindications for metastasectomy.
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References
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- Inoue M, Ohta M, Iuchi K, et al. Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma Ann Thorac Surg 2004;78:238-244.[Abstract/Free Full Text]
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