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J Thorac Cardiovasc Surg 1995;109:599-600
© 1995 Mosby, Inc.

LETTERS TO THE EDITOR

Surgical management for metachronous bronchogenic cancer occurring after pneumonectomy

Cornelis J. J. Westermann, MD, Henry A. van Swieten, MD, Aart Brutel de la Rivière, MD, Jules M. M. van den Bosch, MD, Vincent A. M. Duurkens, MD

St. Antonius Ziekenhuis
3435 CM Nieuwegein, The Netherlands

Reply to the Editor:

Massard, Wihlm, and Morand describe four patients seen in a period of 7 years and we observed eight patients in 4 years: the condition apparently is rare.

The postoperative problems that occurred in two of their four patients indicate the importance of careful preoperative evaluation of pulmonary and cardiac function.

We think that mediastinoscopy is mandatory in all surgical candidates because operation on the remaining lung after previous pneumonectomy should not be done in N2 cases. If necessary, repeat mediastinoscopy is a safe procedure in experienced hands (Meersschaut D, Vermassen F, Brutel de la Rivere A, Knaepen PJ, van den Bosch JMM, Vanderschueren RGJRA. Repeat mediastinoscopy in the assessment in new and recurrent lung neoplasm. Ann Thorac Surg 1992;53:120-2).

We fully agree that resection should be economic, but resection of several segments or a lobe is sometimes possible. We also favor median sternotomy whenever the tumor can be reached through this approach. Video-assisted thoracoscopic surgery (VATS) is a routine procedure in our hospital for pneumothorax, lung biopsy, or benign lesions. However, we do not use the thoracoscopic approach for resection of bronchial carcinoma because VATS violates several principles of oncologic surgery. In patients after pneumonectomy, the intrapleural space needed for VATS will not be sufficient.

We are grateful to Massard, Wihlm, and Morand for their contribution because we think that many patients with resectable bronchial carcinoma in a single lung are denied resection because of the operative risk.

12/8/59363





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