| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
J Thorac Cardiovasc Surg 2001;121:399
© 2001 The American Association for Thoracic Surgery
Letters to the Editor |
Department of Thoracic and Vascular Surgery
University Hospital of Antwerp
Wilrijkstraat 10 B–2650 Edegem (Antwerp), Belgium
To the Editor:
Okada and associates,
1 in their recent article on survival in lung cancer after sleeve lobectomy compared with pneumonectomy, are to be congratulated on their excellent results. They reported a comparative series of 60 sleeve lobectomies and 60 pneumonectomies in which they obtained a 0% mortality for sleeve lobectomy and a 2% mortality for pneumonectomy. Postoperative morbidity was less and overall survival better in the sleeve lobectomy group. In a multivariate analysis, the operative procedure and the T and N factors were independent prognostic factors for survival. For these reasons, sleeve lobectomy is recommended instead of pneumonectomy whenever a complete resection can be obtained by this means.
To obtain equal numbers in both groups, the authors selected 60 sleeve lobectomies from among 151 that were performed during a 15-year period. It would be interesting to know the mortality, morbidity, and overall survival statistics for all 151 consecutive patients so that they could be compared with the 60 patients having pneumonectomy and with other reported series. Also, patients with incomplete resection and those who had noncurative surgery were excluded. However, the authors did not state precisely how many patients were excluded. When the highest mediastinal node was positive, was this an exclusion criterion in the pneumonectomy group as well as in the sleeve lobectomy group?
Rather surprisingly, in both groups 50% of patients had N2 disease, which is the highest number ever reported in a series on sleeve resections. Is this also true for the whole series of 151 sleeve operations? How do the authors perform mediastinal staging preoperatively? Do they rely on computed tomographic or positron emission tomographic scans, or is mediastinoscopy routinely performed before proceeding to thoracotomy? Was any adjuvant therapy given postoperatively in patients with N2 disease? The authors refer to our series of 145 patients who underwent sleeve resection, in which we had a 5-year survival of 31% in a group of 16 patients with N2 disease. 2 However, as most patients in our series (88.3%) had a cervical mediastinoscopy preoperatively, most of the N2 cases were unexpected N2 disease, and many of these had postoperative radiotherapy. In a recent update of our series, the 10-year survival for N2 disease was only 6%. 3 In a multivariate Cox analysis, nodal involvement was found to be the most significant factor determining long-term survival (P < .0001), 3 exactly as in the series of Okada and colleagues. 1 For this reason, one should be careful to perform a primary sleeve resection with N2 disease. Most of our patients with N2 disease are currently included in neoadjuvant trials to determine the optimal treatment for this subset of patients with a poor prognosis.
As already stated in 1987 by Faber, 4 my colleagues and I certainly agree with the authors that a sleeve lobectomy should be performed instead of a pneumonectomy whenever possible. The aim of a complete resection should be to obtain disease-free microscopic margins. In our opinion, N2 disease generally constitutes a contraindication to primary resection, and patients with this stage of the disease should be included in neoadjuvant trials.
12/8/111198
doi:10.1067/mtc.2001.111198
References
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 |
