| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
a Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012 India
b Department of Bioimaging, Tata Memorial Hospital, Mumbai, 400012 India
c Department of Radiotherapy, Tata Memorial Hospital, Mumbai, 400012 India
(Email: cspramesh{at}vsnl.net).
We read with interest Nakayama and colleagues' [1] article on patient outcome after sublobar resections for tumors sized less than 2 cm. The process of calculating a tumor shadow disappearance rate was used to identify patients who would have prolonged survival even with sublobar resections. The authors advocate classifying tumors as "air-containing type" and "solid-density type" on the basis of a tumor shadow disappearance rate of less or more than 50%, respectively. We believe that there are two important reasons to explain the difference in survival between the two groups.
First, the air-containing type would include a large number of ground-glass opacities and, by extension, bronchioloalveolar carcinomas (BACs). This is seen in the results where 38 of 46 air-containing tumors (82.6%) were actually BACs, whereas none of the patients with solid-density tumors had BACs. The superior survival in the air-containing tumors can be partly explained by this, because BACs have a low invasive potential and low propensity to lymph nodal metastases and would have excellent survival even after sublobar surgical excision.
Second, 85% of the patients who underwent sublobar resections for the air-containing type had "intentional" sublobar resections, whereas in the solid-density type, 88% had "compromised" sublobar resections. The difference in survivals between an intentional and compromised sublobar resection has been unequivocally demonstrated in previous studies and, in fact, enlisted in an excellent review by Deslauriers and Gregoire [2].
The Lung Cancer Study Group's randomized trial [3] conclusively proved the superiority of standard anatomic lobectomy compared with sublobar resections. However, it is not infrequent to be faced with patients with small, peripheral, eminently resectable tumors who would be high-risk for formal lobectomy. As seen in the authors' own study, the morbidity of sublobar resections is negligible even in a high-risk group and there should really be no debate about whether sublobar resections are superior to nonoperative treatment options. We, however, believe that this holds true regardless of whether it is a BAC or another histology, because the survival with even solid-density type tumors seen in the authors' study, which was 69% at 5 years, appears unlikely with a nonoperative strategy.
It would be premature to suggest that patients with BACs or air-containing tumors would be equally well treated with sublobar resections as with a lobectomy, primarily because the body of evidence supporting this view is still weak. What Nakayama and colleagues have demonstrated in their article is the ability of preoperative imaging to reliably identify tumors with a good prognosis; its applicability in preselecting patients for sublobar resections should still be considered debatable.
 |
References |
|---|
 Top References |
|---|
Related Article
This article has been cited by other articles:
|
|
 |
|
  H. Nakayama and H. Ito Reply. Ann. Thorac. Surg., November 1, 2008; 86(5): 1724 - 1725. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
