Ann Thorac Surg 2007;84:416
© 2007 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
James W. Asaph, MD
Earle A. Chiles Research Institute, Providence Portland Medical Center, 4401 SW Westdale Dr, Portland, OR 97221-3158
(Email: mrnous{at}aol.com).
Traditionally, surgical mortality and morbidity studies have been limited to "in hospital" or 30-day outcomes. Brunelli and colleagues’ [1] article addresses important issues that only recently have become apparent to most surgeons (ie, long-term concerns beyond "immediate" postsurgical mortality and complications are quite significant). Not only is this information important to patients [2], but it is also information that healthcare policymakers need.
This report is well conceived with good statistical analyses and uses the most updated methods of quality of life analyses to provide excellent outcome data. However, as with many of these studies, this report is based on a relatively small patient population, particularly with patients undergoing more extensive resections such as pneumonectomies and bi-lobectomies, and with "drop-outs" of patients from follow-up for whatever reason, which poses a problem for this type of small study.
The author’s presumption that follow-ups longer than 3 months "introduced an important selection bias" is true; however longer follow-up information is quite relevant to the patient. The role of surgical resection for lung cancer is to achieve a "cure," and cancer recurrence is a failure of that surgical treatment option. In evaluating surgically related long-term quality of life, the presumption is that the patient will be cured of his cancer by the operation. What the patient wishes to know is "what will his quality of life be like if his cancer is cured?" Because most resected lung cancers that are not cured surgically will recur within 2 years, a 2-year follow-up quality of life study may provide the most useful information for the patient.
Interestingly, in an earlier paper by Brunelli and colleagues [3], they demonstrated that pulmonary function was continuing to improve at the 3-month follow-up interval, and the actual and predicted postoperative pulmonary function in their graphs had not leveled, suggesting that there could be further improvement of pulmonary function with time.
 |
References
|
|---|
- Brunelli A, Socci L, Refai M, Salati M, Xiumé F, Sabbatini A. Quality of life before and after major lung resection for lung cancer: a prospective follow-up analysis Ann Thorac Surg 2007;84:410-416.[Abstract/Free Full Text]
- Cykert S, Kissling G, Hansen CJ. Patient preferences regarding possible outcomes after lung resection: what outcomes should preoperative evaluations target? Chest 2000;117:1551-1559.[Medline]
- Brunelli A, Refai M, Salati M, Xiume F, Sabbatini A. Predicted versus observed FEV-1 and DLCO after major lung resection: a prospective evaluation at different postoperative periods Ann Thorac Surg 2007;83:1134-1139.[Abstract/Free Full Text]
Top
References