Ann Thorac Surg 1996;62:1020
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Nael Martini, MD
Department of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021
See also page 1016.
Complete resection is paramount if long-term survival is to be attained in patients with lung cancer regardless of stage. This article by Pitz and colleagues accurately points out that patients with T3 N0 tumors due to proximity to carina do best with complete resection and patients with T3 tumors invading mediastinum do poorest. Interestingly, most of the patients had squamous carcinoma (83%), and nearly all were male. Incomplete resections and the presence of N2 metastases were adverse prognostic factors. Of note is the 10% mortality incurred after pneumonectomy (9/89) and no mortality after lobectomy. This suggests that sleeve lobectomy should have been considered in more patients with T3 carinal disease, especially those with compromised pulmonary function. Also, lesser resections than pneumonectomy for patients with T3 mediastinum might have been appropriate.
Pretreatment mediastinoscopy is important to carefully select those with N2 disease who may benefit from surgical treatment. Although many investigators report no 5-year survivors in the presence of N2 nodal involvement, resection is not necessarily an absolute contradiction if complete excision can be achieved. By careful selection, my colleagues and I have attained survival rates of up to 15% in this subset of patients. More recently, induction chemotherapy or chemoradiation followed by resection is offered to these patients.
Finally, patients presenting with invasion of the mediastinum generally do poorly if treated by operation alone even in the absence of nodal involvement. I believe that this group of patients should receive induction therapy similar to the neoadjuvant trials in patients with N2 disease.
Related Article
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Results of Resection of T3 Non–Small Cell Lung Cancer Invading the Mediastinum or Main Bronchus
- Cordula C. M. Pitz, Aart Brutel de la Rivière, Hans R. J. Elbers, Cees J. J. Westermann, and Jules M. van den Bosch
Ann. Thorac. Surg. 1996 62: 1016-1020.
[Abstract]
[Full Text]
