J Thorac Cardiovasc Surg 2003;125:454-455
© 2003 The American Association for Thoracic Surgery
Safe harbor
Michael Maddaus, MD
From the Department of Surgery, University of Minnesota, Minneapolis, Minn.
Received for publication Sept 13, 2002. Accepted for publication Oct 1, 2002.
Address for reprints: Michael Maddaus, MD, Associate Professor of Surgery, Department of Surgery, University of Minnesota, 420 Delaware St, Box 207, Minneapolis, MN 55455 (E-mail: madda001@umn.edu).
| The first 20% of the full text of this article appears below. |
Surgical dogma has a legitimate role in preventing us from performing operations we should not perform. It defines, often helpfully, the rules of surgical engagement. Break the rules, and your patient may suffer.
One example of dogma is that lobectomy with mediastinal lymph node dissection should be performed for all clinical stage I non-small cell lung cancers.
1 A strict rule such as this places us in a safe harbor, obviating any worry about variables like tumor biology, presence or absence of nodal disease, and pulmonary resection margins. These elements of surgical decision making are rendered moot. After all, the prescribed operation automatically covers all the bases.
At the other extreme, some surgeons may defy dogma and, instead, do what is easier. For instance, just go ahead with a VATS (video-assisted thoracoscopic surgery) wedge resection without lymph node sampling, especially after negative mediastinoscopic results. From this vantage point, intralobar and interlobar lymph node removal may be . . . [Full Text of this Article]
Copyright © 2003 by The American Association for Thoracic Surgery.
