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Ann Thorac Surg 2005;80:1978
© 2005 The Society of Thoracic Surgeons

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Correspondence

How Should Bronchioloalveolar Carcinoma of the Lung 3 Centimeters or Less Be Treated?

Division of Thoracic Surgery and Radiotherapy, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India

(Email: cspramesh{at}vsnl.net).

To the Editor:

We read with interest Sakurai and colleagues' [1] article on bronchioloalveolar carcinoma 3 cm or less in diameter. We agree with the authors that patients with these tumors form a select subset that has a good prognosis. Bronchioloalveolar carcinomas have a low invasive potential and low propensity to lymph nodal metastases, and they have excellent disease specific survival after complete surgical excision. However, we disagree that they can be treated with sublobar resections purely based on the findings of this study. This retrospective study merely identifies these patients as those with good prognosis and low recurrence rates, but in no way does it provide sufficient evidence to recommend sublobar resections. It may even be argued that the authors' excellent results were due to lobectomies being performed on all their patients. In patients with good lung function, lobectomy has little, if any, impact on postoperative quality of life. The morbidity of lobectomy is extremely low with no change in exercise capacity and causes insignificant reductions in forced expiratory volume in 1 second, peak heart rate, oxygen consumption, minute ventilation, oxygen saturation, and respiratory exchange ratio [2]. Although there may be a case for a sublobar resection in patients unfit for lobectomy (based on predicted postoperative lung volumes), fit patients with nonsmall cell lung cancer including T1 bronchioloalveolar carcinoma should continue to undergo lobectomy until stronger evidence points to the equivalence of sublobar resections in this subset of patients. The Lung Cancer Study Group‘s randomized controlled trial [3] conclusively proved the superiority of standard anatomical lobectomy over sublobar resections and the findings of this study do not justify a change from this recommendation.

	References

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1. Sakurai H, Dobashi Y, Mizutani E, et al. Bronchioloalveolar carcinoma of the lung 3 centimeters or less in diametera prognostic assessment. Ann Thorac Surg 2004;78:1728-1733.[Abstract/Free Full Text]
2. Nugent A-M, Steele IC, Carragher AM, et al. Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer Thorax 1999;54:334-338.[Abstract/Free Full Text]
3. Ginsberg RJ, Rubinstein LV, Lung Cancer Study Group Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer Ann Thorac Surg 1995;60:615-622.[Abstract/Free Full Text]

This article has been cited by other articles:

				H. Sakurai, Y. Dobashi, and M. Matsumoto Reply Ann. Thorac. Surg., November 1, 2005; 80(5): 1979 - 1979. [Full Text] [PDF]

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pramesh, C.S. Articles by Agarwal, J. Search for Related Content PubMed PubMed Citation Articles by Pramesh, C.S. Articles by Agarwal, J. Related Collections Lung - cancer