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J Thorac Cardiovasc Surg 2007;133:109-110
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr Joshua Robert Sonett (New York, NY). Dr Petersen, I congratulate you and your colleagues on a nicely presented, well written, and, I believe, important article. The Duke oncology database has enabled the largest review of a single-center result of pulmonary metastasectomy in melanoma. Importantly, the database includes both nonsurgical and surgical patients in the cohort. The primary variable analysis was performed on 318 patients undergoing resection, a carefully selected cohort representing 18% of all patients with pulmonary metastasis in your center. The results of the analysis are reassuring, nicely corroborating the previous work presented by Ugo Pastorini of the international registry of lung metastases, a collaboration of US, Canadian, and European centers. That collaborative registry was created to facilitate the study of results of pulmonary metastasectomy and to divine prognostic variables to guide treatment, much as your study was. When the data were presented in 1997 with 5000 cases, 282 represented patients with melanoma who underwent curative resection. Overall survival of resected patients in that study was 21% at 5 years. And although patients with melanoma histologic type had the worst prognosis of all those with solid tumors in that review, the nearly identical 5-year survival results presented today clearly confirm and validate the utility of pulmonary metastasectomy for select patients with metastatic melanoma. Additionally, the international registry reported a follow-up study of 328 patients in which four groups of risk-stratified variables were defined to help set the standards for delineating the role of metastasectomy in melanoma. Again, these results and stratifications are nicely similar to your reported results, with the additional risk factors that you added of nodular histologic type and extrathoracic metastasis. That . . . [Full Text of this Article]

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Improved survival with pulmonary metastasectomy: An analysis of 1720 patients with pulmonary metastatic melanoma

Rebecca P. Petersen, Steven I. Hanish, John C. Haney, Charles C. Miller, III, William R. Burfeind, Jr, Douglas S. Tyler, Hilliard F. Seigler, Walter Wolfe, Thomas A. D’Amico, and David H. Harpole, Jr
J. Thorac. Cardiovasc. Surg. 2007 133: 104-110. [Abstract] [Full Text] [PDF]