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J Thorac Cardiovasc Surg 2007;134:862-864
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr Donald E. Low (Seattle, Wash). Dr Millien, Dr Sintek, members, and guests, thank you very much. I appreciate the opportunity of discussing this article. I also would like to thank the authors for getting me the manuscript immediately before the meeting for review.

This article describes RFA treatment of 19 patients with stage I disease. All patients were reviewed by thoracic surgeons and were deemed inoperable on medical grounds. The authors should be congratulated in that surgeons not only carried out the assessment of these patients but also delivered the actual RFA therapy in the operating room. This is the third publication from your group examining RFA therapy in different patient populations. Your first study in 2003 examined 18 patients, 5 of whom had NSCLC. The next report in 2005 reported 18 patients, all of whom had NSCLC, but 50% had stage I disease. Clearly you are beyond the point of studying the feasibility of RFA in lung cancer and at a point where the focus should be on results, development of criteria for application of RFA, and, just as importantly, redefinition of criteria for medical inoperability. With that in mind, I believe that in a study of patients with true stage I disease, we should be very careful about opening the door to any nonsurgical approach, except in very carefully documented circumstances. Lung volume reduction surgery has taught us that pulmonary function tests are not the absolute limiting factor about who can undergo surgical intervention. Fifteen of 19 patients in your series were considered inoperable on the basis of "poor pulmonary function test results." However, the only objective indication you documented in your article was mean and median FEV₁. Although it is reassuring that all of your patients were reviewed by thoracic surgeons, your current report . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2007 134: 857-864. [Abstract] [Full Text] [PDF]