HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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 Author home page(s): Hikaru Matsuda Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazama, K. Articles by Matsuda, H. Search for Related Content PubMed Articles by Hazama, K. Articles by Matsuda, H.

Eur J Cardiothorac Surg 2003;23:1078
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Pramesh et al.

Department of Surgery (E1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka 565-0871, Japan

Received 14 March 2003; accepted 17 March 2003.

^* Corresponding author. Tel.: +81-6-6879-3152; fax: +81-6-6879-3164
e-mail: hazama{at}surg1.med.osaka-u.ac.jp

Key Words: Trachea • Cancer • Margins • Postoperative radiotherapy

Indeed we agree to pursue pathological negative margin in performing surgical treatment for malignant diseases, but we should not stick around this concept in managing tracheal malignant tumors.

Postoperative leakage at anastomotic site is not fatal in operation for digestive organ but for trachea. In addition, postoperative radiotherapy has been reported to be effective against residual malignant cells [1,2], we proposed that tension reduction of the anastomosis should take precedence over surgical margin [3]. But this is not always suitable in managing tracheal squamous cell carcinoma representing high grade malignant behavior but in adenoidcystic carcinoma with low grade malignancy, as Dr Pramesh suggested.

Of course, we performed extensive efforts to reduce tension at anastomotic site, but we should refer to Dr Grillo's latest data about the length of cut specimen as long as 6.5 cm [4], as Dr Pramesh had mentioned, and reconfirm surgical procedures and postoperative management to decrease the tension.

Though we have also considered postoperative radiotherapy effective for tracheal malignant tumors, all of the patients did not undergo this adjuvant therapy. Since we did not have common therapeutic strategy for this rare malignant disease, various remedial plans were applied in many hospitals.

I also agree that extensive tracheal surgery should be performed in selected medical centers.

References

1. Grillo H.C., Mathisen D.J., Wain J.C. Management of tumors of the trachea. Oncology 1992;6:61-67.[Medline]
2. Pearson F.G., Todd T.R., Cooper J.F. Experience with primary neoplasms of the trachea and carina. J Thorac Cardiovasc Surg 1974;18:16-29.
3. Hazama K., Miyoshi S., Akashi A., Yasumitsu T., Maeda H., Nakamura K., Tada H., Matsuda H., for the Thoracic Surgery Study Group of Osaka University Clinicopathological investigation of 20 cases of primary tracheal cancer. Eur J Cardiothorac Surg 2003;23:1-5.[Abstract/Free Full Text]
4. Grillo H.C. Development of tracheal surgery: a historical review. Part 1. Techniques of tracheal surgery. Ann Thorac Surg 2003;75:610-619.[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 Author home page(s): Hikaru Matsuda Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazama, K. Articles by Matsuda, H. Search for Related Content PubMed Articles by Hazama, K. Articles by Matsuda, H.