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Eur J Cardiothorac Surg 2003;23:257
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Margaritora et al.

Service de Chirurgie Thoracique, Hopital Europeen Georges Pompidou, 20–40 rue Leblanc, 75015 Paris, France

Received 30 October 2002; accepted 4 November 2002.

* Tel.: +33-1-5609-3450; fax: +33-1-5609-3380
e-mail: marc.riquet{at}hop.egp.ap-hop-paris.fr

Key Words: Neoadjuvant chemotherapy • Chemoradiotherapy • Mediastinoscopy

We thank very much Margaritora and colleagues for giving us the opportunity to clarify our clinical conduct concerning N2. We routinely operate patients referred by different oncological centres, some following neoadjuvant chemotherapy (CT) or chemoradiotherapy (CRT) and others directly addressed for surgery. Also, over the same period, besides the 2048 patients operated on without neoadjuvant therapy (NAT), we also operated on 422 patients after NAT (CT n=349, CRT n=73).

Indication for NAT was N2 in 158 cases (37.4%, versus 26.6% without NAT); 5-year survival rate was 26.7% without NAT and 24.4% after NAT (not significant), despite the indication for NAT being initial irresectability in two-thirds of N2 patients.

Early in our experience every clinical N2 patient who appeared resectable was scheduled for surgery. Over the last years, NAT was proposed to the majority of clinical N2 patients, provided that histologic proof was obtained. In this subset of patients, NAT seems to be beneficial [1,2].

To the best of our knowledge, there is no definitive study demonstrating the benefit of NAT in pathological microscopic N2. In this subset of patients, we favor a surgical approach without NAT and mediastinoscopy did not modify our approach, and therefore was omitted. If neoadjuvant CT would prove its usefulness, would this justify routine mediastinoscopy? In fact, in our series routine mediastinoscopy would have been useless in more than 90% of cases [3] and in the remaining cases it would have had to be at least equivalent to complete lymphadenectomy.

References

1. Margaritora S., Cesario A., Galetta D., Granome P. Mediastinoscopy as a standardized procedure for mediastinal lymph-node staging in non-small cell carcinoma. Do we have to accept the compromise?. Eur J Cardiothorac Surg 2001;20:652-653.[Free Full Text]
2. Andre F., Grunenwald D., Pignon J.P., Dujon A., Pujol J.L., Brichon J.Y., Brouchet L., Quoix E., Westeel V., Le Chevalier T. Survival of patients with resected N2 non-small-cell lung cancer: evidence of a subclassification and implications. J Clin Oncol 2000;18:2981-2989.[Abstract/Free Full Text]
3. Dujon A., Le Pimpec Barthes F., Saab M., Riquet M. Routine mediastinoscopy and lymph node staging: ‘much ado about nothing’. Eur J Cardiothorac Surg 2002;22:485-494.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dujon, A. Articles by Riquet, M. Search for Related Content PubMed Articles by Dujon, A. Articles by Riquet, M. Related Collections Lung - cancer