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Eur J Cardiothorac Surg 2007;32:185-186. doi:10.1016/j.ejcts.2007.03.026
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France
Received 13 March 2007; accepted 15 March 2007.
* Corresponding author. Address: Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, 133 Avenue de la Resistance, 92350 Le Plessis Robinson, France. Tel.: +33 140948573; fax: +33 146308562. (Email: byildizeli{at}marmara.edu.tr).
Key Words: Sleeve lobectomy • Bronchoplastic resection • Lung cancer • Complications • Survival
We appreciate the comments of Dr Ismail [1] regarding our study. In response, there are a few clarifications to be made. If history, physical examination, and initial laboratory screening results are negative, the likelihood of finding metastatic disease on subsequent staging procedures for the patients with lung cancer is low. According to American College of Chest Physicians evidence-based guidelines (1997), patients with clinical stage I and II lung cancer and normal results of a clinical evaluation require no further imaging for detection of extrathoracic disease. Therefore, we perform bone scanning in symptomatic patients or in patients with abnormal blood work. On the other hand, the use of positron emission tomography (PET) in the evaluation and management of patients with malignancy continues to increases. Since PET has similar sensitivity, although poorer specificity, when compared with the isotope bone scan [2], we do not need to perform any further investigations for patients who have negative PET scan.
Secondly, it is one of the most difficult parts of the retrospective studies to update patients’ files to the modern era. However,we have reviewed our pathological files according to the New International Staging System for Lung Cancer (1997).
Clinically, it is difficult to distinguish a second primary carcinoma from a metastatic lesion arising from a first tumor. To differentiate between second or multiple primary lung cancers and recurrence or satellite nodules, we used the criteria adopted by Antakli et al. [3]. In this regard, five patients with a history of lobectomy for contralateral lung cancer had a second primary lung cancer, because all had a different histology. We classified one of our patients having a synchronous contralateral lung cancer because he also had a biopsy proven different histologic malignancy.
The anastomosis between the tracheobronchial bifurcation and the bronchus intermedius is well described elsewhere [4]. In our study [1], we did not include the patients for whom we have performed carinal resection with lobar resection. For those patients, as the author well knows that following the first anastomosis between the trachea and the left main bronchus, the bronchus intermedius is anastomosed 1 cm below the initial anastomosis to the left main bronchus.
We do not agree with the author's claim that patients with poor pulmonary reserve for the pneumonectomy should have neoadjuvant therapy. In fact, as we well know that bronchoplastic procedures were introduced for patients with impaired pulmonary functions. However, pneumonectomy was contraindicated in our 80 patients and the outcome was not affected by the presence of preoperative contraindications to pneumonectomy and incomplete resection. Since the main adverse prognostic factor for patients with lung cancer is N2 disease, we agree with the author that for those patients other treatment modalities should be considered to achieve long term survival. We underline that sleeve lobectomy should be performed for patients without N2 disease who are anatomically appropriate regardless of whether they would tolerate a larger resection.
Finally, regarding the first sleeve lobectomy for a lung cancer, we know that it was reported in 1954 by Allison [5].
References
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