Ann Thorac Surg 2007;84:958
© 2007 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited commentary
Robert James Cerfolio, MD
Department of Cardiothoracic Surgery, University of Alabama at Birmingham, 703 19th St S, ZRB 736, Birmingham, AL 35294
(Email: robert.cerfolio{at}ccc.uab.edu).
Simón and associates [1] have presented a retrospective report based on a prospective multi-institutional database. There are a large number of patients in this study and this fact along with the long, 10-year follow-up data make it clinically important. Although there are several concerns about the methodology and some of the results are quite unusual, this article is clinically important and well-written. First, 97% of the patients who had pneumonectomy and 91.5% of the rest of the patients (who had lobe or bi-lobectomy) were men. Second, no patient received neoadjuvant therapy, and yet a very large number (421 of 1,475 [40%]) underwent pneumonectomy. Third, we are led to believe that few, if any, of the lobectomies were sleeves of either the bronchus or of the pulmonary artery. Finally, 59% of the patients who underwent pneumonectomy had stage I disease, and this is quite high, especially when one considers that the median size of the tumor in these patients was only 5.1 cm. However, despite these concerns the authors have delivered several important findings.
Simón and associates’ [1] report, despite not specifically commenting on sleeve lobectomy, suggests that lung-sparing procedures provide a higher survival than pneumonectomy. This supports the practice of avoiding a pneumonectomy, unless one is unable to perform an R0 resection in any other manner. This study also sets realistic benchmarks for the expected mortality from lobectomy (4.4%) as well as pneumonectomy. Finally and most provocatively, the article also shows that pneumonectomy for stage II disease (patients with metastatic N1 lymph nodes) provides improved survival, not just local control. This finding was only true for left-sided pneumonectomy and may suggest that the oncologic advantage of performing a right-sided pneumonectomy for stage II disease is lost by the possible cardiopulmonary morbidity that occurs with right-sided mediastinal shifting. Further studies are needed to provide specific data on the cause of death in these patients.
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References
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- Simón C, Moreno N, Peñalver R, González G, Alvarez-Fernández E, González-Aragoneses F, Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery The side of pneumonectomy influences long-term survival in stage I and II non-small cell lung cancer Ann Thorac Surg 2007;84:952-958.[Abstract/Free Full Text]
Related Article
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The Side of Pneumonectomy Influences Long-Term Survival in Stage I and II Non-Small Cell Lung Cancer
- Carlos Simón, Nicolás Moreno, Rafael Peñalver, Guillermo González, Emilio Alvarez-Fernández, Federico González-Aragoneses Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery
Ann. Thorac. Surg. 2007 84: 952-958.
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