Is palpation of the nonresected pulmonary lobe(s) required for patients with non-small cell lung cancer? A prospective study

被引:29
作者
Cerfolio, Robert James [1 ]
Bryant, Ayesha S. [2 ]
机构
[1] Univ Alabama Birmingham, Div Cardiothorac Surg, Birmingham, AL 35294 USA
[2] Univ Alabama, Sch Publ Hlth, Dept Epidemiol, Div Cardiothorac Surg,Dept Surg, Tuscaloosa, AL 35487 USA
关键词
D O I
10.1016/j.jtcvs.2007.08.062
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Video-assisted lobectomy is an increasingly used technique to treat patients with non-small cell lung cancer but it does not usually afford lung palpation. Methods: A prospective study was conducted on patients with tumors amenable to video-assisted lobectomy (noncentral lesion and,5 cm) who underwent open lobectomy via thoracotomy. All patients underwent 64-slice helical computed tomographic scan with intravenous contrast at 5-mm intervals and had integrated 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography computed tomography 30 days or less before thoracotomy. Unsuspected malignant pulmonary nodules that were palpated and removed (from a different lobe than the one resected) and that were not imaged preoperatively were defined as cancer that would have been missed by video-assisted lobectomy. Results: From January 2006 to February 2007, 166 patients had non-small cell lesions that were resected via thoracotomy, despite being amenable to video-assisted surgery, by one surgeon. Thirty-seven (22%) patients had pulmonary nodules that probably would have been missed by video-assisted lobectomy; 14 (8.4%) of these nodules were malignant. These were unsuspected M1 pulmonary lesions in 9 patients and unsuspected different types of primary non -small cell lung cancers in 5 patients. All missed lesions were less than 6 mm and in different lobes from the one resected. Nine (64%) of these 14 patients' primary known lesions were pathologic T1 lesions. Nine patients received adjuvant chemotherapy because of these unsuspected M1 nodules. Conclusions: Open lobectomy that affords palpation of the rest of the lung may discover nonimaged malignant pulmonary nodules in different lobes in 8% to 9% of patients with non -small cell lung cancer despite preoperative fine-cut chest computed tomographic scan with contrast and integrated integrated 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography computed tomographic scanning. The clinical impact of these findings is unknown.
引用
收藏
页码:261 / 268
页数:8
相关论文
共 24 条
[1]   The maximum standardized uptake values on positron emission tomography of a non-small cell lung cancer predict stage, recurrence, and survival [J].
Cerfolio, RJ ;
Bryant, AS ;
Ohja, B ;
Bartolucci, AA .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005, 130 (01) :151-159
[2]   Improving the inaccuracies of clinical staging of patients with NSCLC: A prospective trial [J].
Cerfolio, RJ ;
Bryant, AS ;
Ojha, B ;
Eloubeidi, M .
ANNALS OF THORACIC SURGERY, 2005, 80 (04) :1207-1214
[3]   The accuracy of endoscopic ultrasonography with fine-needle aspiration, integrated positron emission tomography with computed tomography, and computed tomography in restaging patients with esophageal cancer after neoadjuvant chemoradiotherapy [J].
Cerfolio, RJ ;
Bryant, AS ;
Ohja, B ;
Bartolucci, AA ;
Eloubeidi, MA .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005, 129 (06) :1232-1241
[4]   Intercostal muscle flap reduces the pain of thoracotomy: A prospective randomized trial [J].
Cerfolio, RJ ;
Bryant, AS ;
Patel, B ;
Bartolucci, AA .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2005, 130 (04) :987-993
[5]   Intracostal sutures decrease the pain of thoracotomy [J].
Cerfolio, RJ ;
Price, TN ;
Bryant, AS ;
Bass, CS ;
Bartolucci, AA .
ANNALS OF THORACIC SURGERY, 2003, 76 (02) :407-411
[6]   A prospective, double-blinded, randomized trial evaluating the use of preemptive analgesia of the skin before thoracotomy [J].
Cerfolio, RJ ;
Bryant, AS ;
Bass, CS ;
Bartolucci, AA .
ANNALS OF THORACIC SURGERY, 2003, 76 (04) :1055-1058
[7]   PULMONARY RESECTION OF METASTATIC RENAL-CELL CARCINOMA [J].
CERFOLIO, RJ ;
ALLEN, MS ;
DESCHAMPS, C ;
DALY, RC ;
WALLRICHS, SL ;
TRASTEK, VF ;
PAIROLERO, PC .
ANNALS OF THORACIC SURGERY, 1994, 57 (02) :339-344
[8]   Thoracoscopic lobectomy: Evolving and improving [J].
D'Amico, Thomas A. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006, 132 (03) :464-465
[9]   Intrapleural intercostal nerve block associated with mini-thoracotomy improves pain control after major lung resection [J].
D'Andrilli, Antonio ;
Ibrahim, Mohsen ;
Ciccone, Anna Maria ;
Venuta, Federico ;
De Giacomo, Tiziano ;
Massullo, Domenico ;
Pinto, Giovanni ;
Rendina, Erino A. .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2006, 29 (05) :790-794
[10]   Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma [J].
Kayton, ML ;
Huvos, AG ;
Casher, J ;
Abramson, SJ ;
Rosen, NS ;
Wexler, LH ;
Meyers, P ;
LaQuaglia, MP .
JOURNAL OF PEDIATRIC SURGERY, 2006, 41 (01) :200-204