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Eur J Cardiothorac Surg 2005;27:731
© 2005 Elsevier Science NL

Letter to the Editor

Chest wall resection in patients with non-small cell lung cancer

C.S. Pramesh*, Rajesh C. Mistry, Jaiprakash Agarwal

Division of Thoracic Surgery and Radiotherapy, Tata Memorial Hospital, Mumbai, India

Received 20 December 2004; accepted 10 January 2005.

* Corresponding author. Address: Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai 400 012, India. Tel.: +91 22 24177000; fax: +91 22 24146937. (E-mail: cspramesh{at}vsnl.net).

Key Words: Non-small cell lung cancer • Chest wall resection • Survival • Prognosis

We read with interest Matsuoka and colleagues’ article [1] on chest wall resection for non-small cell lung cancer (NSCLC) and their analysis of prognostic factors. We agree with their conclusions that completeness of resection and mediastinal nodal status are the most important prognostic factors in patients with chest wall invasion. Whether to do an extrapleural excision or en bloc resection including the chest wall and ribs has been controversial [2]. Our policy with surgical resection of these tumors is to perform extrapleural resections (without chest wall excision) in patients whose tumors have superficial adhesions to the parietal pleura. We perform en bloc excisions in patients with obvious chest wall infiltration or dense adherence to the parietal pleura or when extrapleural excision has been unsatisfactory. This has been known to improve completeness of resection in patients with pleural or chest wall infiltration [2]. The recent article is however unclear on a few points which we feel are important. We wonder whether the patients who had pathological N2 or N3 disease underwent neoadjuvant or postoperative chemotherapy as this is something which could have improved outcomes in these patients. Randomized trials [3–5] have shown significantly improved survival with chemotherapy. We are also very interested in the outcome of patients who underwent ‘incomplete’ resection. How many of these patients had gross residual disease and how many had only microscopic positive margins or positive pleural lavage cytology? Was there a difference in survival between the two? Were patients with residual disease, macroscopic or microscopic treated with postoperative radiotherapy? What were the patterns of recurrence in patients with incompletely resected disease? Though these predominantly involve a subgroup of patients excluded by the authors in this study, elaboration of these points would add definite value to the paper.

References

  1. Matsuoka H, Nishio W, Okada M, Sakamoto T, Yoshimura M, Tsubota N. Resection of chest wall invasion in patients with non-small cell lung cancer. Eur J Cardiothorac Surg 2004;26:1200-1204.[Abstract/Free Full Text]
  2. Albertucci M, DeMeester TR, Rothberg M, Hagen JA, Santoscoy R, Smyrk TC. Surgery and the management of peripheral lung tumors adherent to the parietal pleura. J Thorac Cardiovasc Surg 1992;103:8-12.[Abstract]
  3. Roth JA, Fossella F, Komaki R, Ryan MB, Putnam Jr JB, Lee JS, Dhingra H, DeCaro L, Chasen M, McGavran M, Atkinson EN, Hong WK. A randomized trial comparing perioperative chemotherapy and surgery with surgery alone in resectable stage III A non-small cell lung cancer. J Natl Cancer Inst 1994;86:673-680.[Abstract/Free Full Text]
  4. Rosell R, Gomez-Codina J, Camps C, Maestre J, Padille J, Canto A, Mate JL, Li S, Roig J, Olazabal A, Canela M, Ariza A, Skacel Z, Morera-Prat J, Abad A. A randomized trial comparing preoperative chemotherapy and surgery with surgery alone in patients with non-small cell lung cancer. N Engl J Med 1994;330:153-158.[Abstract/Free Full Text]
  5. The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004;350:351-360.[Abstract/Free Full Text]




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