Eur J Cardiothorac Surg 2002;21:900
© 2002 Elsevier Science NL
Editorial Comment: Bando T, et al. A new method of segmental resection for primary lung cancer: intermediate results
K. Jeyasingham*
‘Stonycroft’, 18 Quarry Lane, Winterbourne Down BS36 1DB, South Gloucestershire, UK
* Tel.: +44-1454-773691; fax: +44-117-970-1960
e-mail: jeyasingham{at}btinternet.com
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Introduction
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 Introduction
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This paper by Drs. Bando et al. introduces several unconventional issues into the management of primary lung cancer, and the evaluation of the results of management.
First and foremost, it must be clearly understood that the paper analyses retrospectively a series of patients treated by limited resection. In the 8-year period from January 1993 to December 2000, a total of 213 patients with T1N0M0 primary lung cancer underwent lung resection. The authors do not explain why 132 patients had a standard lobectomy, whilst 74 underwent "a pulmonary artery guided segmentectomy". Did the 132 patients have features which rendered them unsuitable for a segmental resection, or was the selection purely incidental (and clearly not in a randomized fashion)? In either case, the conclusions as to whether segmental resection is a suitable alternative to lobectomy would be misplaced.
Secondly, the authors describe two groups of patients having segmental resection, viz. Intentional Segmental Resection and Compromised Segmental Resection, the former with good lung function, and the latter with compromised lung function. It is not clear if the histology of the tumours was available prior to surgery or after. Judging by the proportion of the histological types, one is led to conclude that in the vast majority a pre-operative histological typing was known prior to surgery, and that at least in a small proportion the final histology was only confirmed after resection. The inclusion of three patients with small cell carcinoma, without pre-operative chemotherapy in each of the two groups, is worthy of note in this context. The higher proportion of the 21–30 mm tumours (13/33) in the compromised resection group as opposed to 8/41 in the intentional resection group suggests that some form of pre-selection of these larger tumours, for elective lobectomy, was built into the series.
Thirdly, the authors state that as a rule, oral chemotherapy with a 5-fluorouracil derivative was administered for more than 1 year. The use of a single-agent chemotherapy for an ill-defined period in the post-operative management of primary lung cancer is unconventional and without proven efficacy.
The main purpose in presenting this paper appears to be to describe a new technique of limited resection, which the authors define as "a pulmonary artery-guided segmental resection". The technique certainly appears to lend flexibility for the surgeon to vary the extent and plane of resection to suit the position of the tumour nodule. As the authors themselves explain, this may be the case when the tumour is situated close to the inter-segmental plane of cleavage. The surgeon performing a classical segmentectomy, described by Belsey and Churchill, based on the segmental anatomy of the bronchial tree demonstrated by Brock, and adopted by Jensik for the surgical removal of primary lung cancer in the compromised lung function patient, would in such situations remove two contiguous segments. This would ensure removal of adequate pulmonary tissue and the associated lymphatic channels. The technique described by Drs. Bando et al. would be justified if bisegmentectomy was not an option, but lends itself to the criticism of transgressing pulmonary and lymphatic channels in the management of lung cancer. One fails to see its justification in treating patients with adequate lung function.
