Ann Thorac Surg 2005;79:1697
© 2005 The Society of Thoracic Surgeons
Original articles: General thoracic: Invited commentary
INVITED COMMENTARY
Ryosuke Tsuchiya, MD
Division of Thoracic Surgery, National Cancer Center Hospital, 1-1, 5-Chome, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
(E-mail: rtsuchiy{at}ncc.go.jp).
The results of resection of locally advanced (T4) nonsmall cell lung cancer with cardiopulmonary bypass reported by de Perrot are acceptable. After advanced techniques of cardiovascular surgery and orthopedics were introduced to thoracic surgery, the safety of operations for T4 lung cancers was improved. In addition, advances in airway management during operation by anesthesiolosists encouraged surgeons to attempt airway reconstructions for advanced lung cancer. Several reports with good results after sleeve pneumonectomy have been reported since Dartevelle's article reporting 50 patients. Adding cardiopulmonary bypass to airway surgery makes it easy to manage the airway during operation and to reduce postoperative morbidity. Unfortunately, outcomes of surgery for lung cancer invading the great vessels are not improved even with cardiopulmonary bypass. Induction chemotherapy or chemoradiotherapy is recommended to control occult distant metastasis and to improve the local curability of the operation [1]. Accurate selection of candidates for surgery is another important factor for improving the results of surgery for T4 lung cancer because most of the patients with T4 lung cancer have occult distant metastasis. In addition to whole body computed tomography, brain magnetic resonance imaging, bone scintigraphy and tumor markers, a positron emission tomographic scan is a good candidate for a clinical trial to detect distant metastasis before operation [2]. Accurate preoperative staging is essential for selecting patients with T4 lung cancer for extensive surgery and possible complete resection.
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- Grunenwald DH, Andre F, Le Pechoux, et al. Benefit of surgery after chemoradiotherapy in stage IIIB (T4 and/or N3) non-small cell lung cancer J Thorac Cardiovasc Surg 2004;122:796-802.
- Schrevens L, Lorent N, Dooms C, Vansteenkiste J. The role of PET scan in diagnosis, staging, and management of non-small cell lung cancer staging, and management of non-small cell lung cancer Oncologist 2004;122:796-802.
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