Ann Thorac Surg 2005;80:1565
© 2005 The Society of Thoracic Surgeons
Correspondence
Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer: Reply
Giovanni Vicidomini, MD, PhD,
Mario Santini, MD,
Vincenzo Pastore, MD
Department of Thoracic Surgery Seconda Università di Napoli Piazza Miraglia, 2 Naples 80138 Italy
(Email: gmvicidomini{at}yahoo.it).
To the Editor:
We thank Dr P ramesh and associates [1] for their valuable remarks and interest in our work [2]. The article reported the results of our initial experience with intraoperative pleural lavage in 84 patients undergoing major lung resection for nonsmall cell lung cancer. Our results confirm those of other authors and suggest that pre-resectional pleural lavage is able to detect patients with a high risk of recurrences after lung resection. The statistical analysis showed a significant difference in survival between patients with positive and patients with negative pleural lavage cytology (PLC) (p = 0.025). As remarked by Pramesh, the patients with positive pleural lavage had a 3-year survival of only 30%. Unfortunately, as already mentioned in the "Results" section of our article and in the meeting "Discussion" after the presentation, the small number of our series prevented us to define the relationship between survival status and T-classification of the tumors. We agree with Pramesh that the series is too limited for definitive conclusions, and in our current clinical practice we do not exclude patients from surgery on the sole basis of PLC. However, our experience, similar to that of other research groups with larger series of patients, suggests that the presence of malignant cells in the pleural cavity worsens the prognosis of the disease. As speculated by Okada and colleagues [3], the positive pleural lavage cytology is probably indicative of subclinical pleural dissemination or a stage previous to pleural dissemination. We hope that in the next future trial (the ACOSOG Z0040 trial [4] that is evaluating the prognostic role of occult metastases in 1,200 patients), all the questions regarding this particular subject may be clarified. The results of that trial should indicate if patients with positive PLC deserve an additional treatment before or after surgery. In cases of an affirmative response, the preoperative application of this procedure (eg, through video-assisted thoracoscopy), could allow the selection of patients to be treated by a neoadjuvant regimen before surgery.
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References
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- Pramesh CS, Mistry RC, Agarwal J. Intraoperative pleural lavage cytology should not influence decision for radical surgery in nonsmall cell lung cancer(letter) Ann Thorac Surg 2005;80:1564.[Free Full Text]
- Vicidomini G, Santini M, Fiorello A, Parascandolo V, Calabro B, Pastore V. Intraoperative pleural lavageis it a valid prognostic factor in lung cancer?. Ann Thorac Surg 2005;79:254-257.[Abstract/Free Full Text]
- Okada M, Sakamoto T, Nishio W, Uchino K, Tsuboshima K, Tsubota N. Pleural lavage cytology in non-small cell lung cancerlessons from 1000 consecutive resections. J Thorac Cardiovasc Surg 2003;126:1911-1915.[Abstract/Free Full Text]
- American College of Surgeons Oncology Group. Z0040 Trial (Study Chair: Cohen R): a prospective study of the prognostic significance of occult metastases in the patient with resectable non-small cell lung carcinoma..
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Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer
- C.S. Pramesh, Rajesh C. Mistry, and Jaiprakash Agarwal
Ann. Thorac. Surg. 2005 80: 1564.
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