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J Thorac Cardiovasc Surg 2011;142:552-553
© 2011 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Steven R. DeMeester (Los Angeles, Calif). I congratulate Dr Fabian and coauthors on an excellent manuscript and presentation.

In this study, the authors address a clinically important issue—what to do with SMPLC by assessing the survival after resection of these simultaneous lesions. Although the title indicates that the patients were N2 node negative, there were in fact 2 patients who had positive N2 nodes. Why were these patients included in your analysis? Were these patients who did not have mediastinoscopy? Should mediastinoscopy be essential in all of these patients?

Dr Fabian. That is a good point. We elected to include them because they cover the gamut of the disease that we deal with. Both patients had bilateral tumors. Both had mediastinoscopy preoperatively, which discovered single-station N2 disease. Both patients underwent neoadjuvant therapy preoperatively, subsequent restaging, and then resection.

Dr DeMeester. Second, you mentioned that the synchronous cancers were detected preoperatively, intraoperatively, or on final pathologic examination. Did you evaluate survival on the basis of how the lesion was found? In other words, if it was found pathologically, did that imply a different survival than if it was known preoperatively? Did the number of lesions affect survival in these patients?

Dr Fabian. That is a very good point. We did not look at it. We do know that in the overwhelming majority of our patients in this series, we had the knowledge of preoperative diagnosis, particularly 44 with bilateral tumors. As well as the majority of the 18 ipsilateral lesions in different lobes. There were only 5 ipsilateral same lobe so I don't think we could determine much from these data. But I do think it is a good point and worth considering.

Dr DeMeester. The data presented by your group as well as from previous publications all show that . . . [Full Text of this Article]