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J Thorac Cardiovasc Surg 2005;129:727-729
© 2005 The American Association for Thoracic Surgery

Editorial

Surgical intervention for T4 lung cancer with infiltration of the thoracic aorta: Are we back to the archetype of surgical thinking?

Medical University of Vienna, Department of Cardiothoracic Surgery, Vienna, Austria.

Received for publication August 24, 2004; accepted for publication August 27, 2004.

^_* Address for reprints: Walter Klepetko, MD, Professor of Special Thoracic Surgery, Medical University of Vienna, Department of Cardiothoracic Surgery, Waehringer Guertel 18-20, A-1090 Vienna, Austria. (E-mail: walter.klepetko@meduniwien.ac.at).

The first 20% of the full text of this article appears below.

See related article on page 804.

 

The philosophy that radical surgical resection of all malignant tissue can be curative, even for advanced tumors, has widely influenced the therapeutic thinking of surgeons in the early days and, to some degree, still remains alive in many surgeons at present. In view of our modern understanding of tumor biology in general and the grim prognosis of bronchial cancer in particular, the value of such extended operations must, however, seriously be questioned. In this issue of the Journal, the article "Surgical resection for lung cancer with infiltration of the thoracic aorta" by Ohta and colleagues¹ again raises the question of whether surgical intervention for advanced tumors, particularly for T4 tumors with infiltration of the large vessels, can inhere oncologic benefit for our patients or rather must be seen as an extreme operation, which is more of technical attractiveness to the surgeon than of therapeutic value for the patient.

The question can be approached from different sides. Above all, one has to ask for the statistical proof of the survival advantage for patients treated for locally advanced T3/T4 bronchial cancer. One must accept that this advantage can hardly be demonstrated from the existing literature. All documented experience about surgical intervention for T3/T4 non-small cell lung cancer has been collected in rather small series only,^2–4 which is in clear contrast to the large number of patients that usually is necessary to demonstrate treatment benefit of only moderate extent. For example, in a recently published prospective randomized study by the International Adjuvant Lung . . . [Full Text of this Article]

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