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J Thorac Cardiovasc Surg 2007;134:1271-1272
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Discussion

Dr Wood. Dr. Veronesi, congratulations on very good work by you and your group on a complex group of patients. These are difficult patients, and you certainly got good results both in operative outcomes as well as in survival in a group of patients with advanced disease.

I wanted to emphasize a couple of points that were more in your paper than in the presentation. One was this aspect of clinical overstaging of T4 disease. In your series you found it 15% of the time. There is a series from about four years ago in the European Journal of Cardiothoracic Surgery that found clinical overstaging of T4 disease 40% of the time. I think that it is important to emphasize this experience since often a thoracic surgeon will not see these patients because they are clinically staged as T4 and felt to be unresectable. Or we may see them and deny surgical consideration for the same reason, yet they may really have T2-3 disease due to overstaging. This is one important aspect of looking at patients with locally advanced disease.

My first question is whether you think there really is a difference between T3 and T4 disease. You said that was a limitation of your study, but is there biologically any reason that there is a difference between T3 disease and T4 disease, and should we treat them any differently if we can achieve a complete resection?

Dr Veronesi. When I say limitation of the study, I mean that the group of chest wall resection and diaphragm resection doesn’t reach the common definition of extended resections in . . . [Full Text of this Article]

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