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J Thorac Cardiovasc Surg 1997;114:302
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Tumor dissemination after video-assisted thoracic surgery: What does it mean?

Robert J. Downey, MD, Patricia McCormack, MD

Division of Thoracic Surgery,
Memorial Sloan-Kettering Cancer Center,
New York, NY 10021

Joseph LoCicero , III, MD

Division of Thoracic Surgery
New England Deaconess Hospital
Boston, MA 02215

Reply to the Editor:

We appreciate the comments of Drs. Hermansson, Konstantinov, and Aren in response to our article. Unfortunately, they have misread our conclusion, which may be summarized as follows: The case reports presented raise concerns that the techniques of manipulation of malignant tissue during VATS procedures, regardless of the extent of resection, may lead to an increased rate of suture line occurrences; this increase is the result of inadequate tissue margins caused by an inability to palpate extent of disease. Furthermore, the reported cases raise concerns that disruption of tumor-bearing tissue with implantation within the pleural cavity or within chest wall incisions occurs at rates higher than seen during open thoracotomy and intrathoracic resections. The technique they recommend of placing specimens into sealed bags before withdrawal from the chest is reasonable and may spare incisional contamination; however, this will not relieve concerns regarding inadequate margins or disruption within the pleural cavity.

The morbidity and mortality of open procedures for the resection of intrathoracic malignant tumors are well documented in the literature, as is the previously vanishing rare problem of tumor implantation in an incision. Before VATS techniques are generally adopted, we advocate well-designed trials that will document both that VATS techniques are as safe as open techniques and that, stage for stage, VATS techniques provide 3- and 5-year survivals equal to or better than those achieved with open techniques.

12/8/82099





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