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Eur J Cardiothorac Surg 2005;28:913
© 2005 Elsevier Science NL

Letters to the Editor

Reply to Shanmugan et al.

Hidehito Matsuoka a , * , Morihito Okada b , Toshihiko Sakamoto b , Noriaki Tsubota b

a Department of Surgery, Hyogo Prefectural Kaibara Hospital, 5208-1, Kaibara, Kaibara-cho, Tanba City, Hyogo 669-3395, Japan
b Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Hyogo, Japan

Received 15 September 2005; accepted 20 September 2005.

* Corresponding author. Tel.: +81 795 72 0524; fax: +81 795 72 1276. (Email: hmatsuoka1{at}mac.com).

Key Words: Non-small cell lung cancer • Elderly patients • Limited resection

We appreciate Shanmugan et al.'s suggestive letter regarding our article [1]. We would like to make the following comments.

In the study reported by Ginsberg and Rubinstein [2], many wedge resections were mixed with segmentectomies. We deem that inadequate surgical margin of wedge resection caused the high rate of local relapse. The 5-year survival rate of the patients, who underwent extended segmentectomies for peripheral non-small cell lung cancers less than 2 cm on chest roentogenograms and with no evidence of distant or lymph node metastasis, was 91.8% excluding patients who died of other diseases [3,4]. The 5-year survival rate of the patients, including those who died, was 81.8%. In this study, the mean age of these eligible registered patients was 63.4 (±8.8) years. We conclude that extended segmentectomy can be a reasonably ‘curative’ option in those with such early and small lung tumors regardless of their ages.

We agree that case selection is the most important matter especially for elderly patients. In our study, those with stage 3A disease got locally curative resections. Nevertheless, they had distant relapses relatively quickly. We do not agree to operate on a patient with clinical N2, especially on a patient of octogenarian. We completely agree about your comment concerning pneumonectomy. Pneumonectomy is a disease, as Dr Urschel said. We seldom do pneumonectomy even below 80, needless to say over 80. When we read papers from Europe, we always wonder why the ratio of the procedure is high.

Our first choice of procedure to an octogenarian is a segmentectomy. If this procedure is not adequate for some reasons, wedge resection is the second and a lobectomy is the third choice. Pneumonectomy is never chosen for them. It is our policy [5].

Though it is not easy to believe now, in Japan we had the time when the life seemed to be only 50 years. Future people may wonder about the present day that defines the octogenarians as ‘the elderly’.

References

  1. Matsuoka H, Okada M, Sakamoto T, Tsubota N. Complications and outcomes after pulmonary resection for cancer in patients 80 to 89 years of age. Eur J Cardiothorac Surg 2005;28:380-383.[Abstract/Free Full Text]
  2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study. Ann Thorac Surg 1995;60:615-622.[Abstract/Free Full Text]
  3. Tsubota N, Ayabe K, Doi O, Mori T, Namikawa S, Taki T, Watanabe Y. Ongoing prospective study of segmentectomy for small lung tumors. Ann Thorac Surg 1998;66:1787-1790.[Abstract/Free Full Text]
  4. Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T. Prospective study of segmentectomy for small lung tumors: the final report. Ann Thorac Surg 2002;73:1055-1059.[Abstract/Free Full Text]
  5. Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller?. Ann Thorac Surg 2001;71:956-960.[Abstract/Free Full Text]




This Article
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Hidehito Matsuoka
Noriaki Tsubota
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Right arrow Articles by Matsuoka, H.
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