HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marc Riquet Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Riquet, M. Articles by Lang-Lazdunski, L. Search for Related Content PubMed PubMed Citation Articles by Riquet, M. Articles by Lang-Lazdunski, L.

J Thorac Cardiovasc Surg 2001;121:1224-1225
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Results of surgical treatment of lung cancer involving the diaphragm

Department of Thoracic Surgery
Hôpital Européen Georges Pompidou
20 rue Leblanc
75015 Paris, France

To the Editor:

We read with interest the article by Yokoi and associates ¹ regarding the results of surgical treatment of lung cancer invading the diaphragm. In their series, 37 patients were found to have exclusive invasion of the diaphragm and had complete en bloc resection, whereas 18 patients also had resection of neighboring structures. The 5-year survivals of patients with completely resected T3 N0 M0 tumors (n = 26) and T3 N1-2 M0 tumors (n = 29) were 28.3% and 18.1%, respectively (P = .013). In-depth invasion of diaphragm was the other factor significantly affecting survival, with a 5-year survival of 33% in patients with shallow invasion and 14.3% in patients with deep invasion (P = .036). Those results are not in accordance with those recently published by our group. ² In our study, 5-year survival was not significantly influenced by the degree of pathologic invasion of the diaphragm, and prognosis appeared grossly as bad in N0 cases as in N1-N2 cases, when studying patients with complete resection including radical mediastinal lymph node dissection.

N1-2 disease was less prevalent in their series than in our recently published series (52% vs 67%), but only some of their patients had complete mediastinal lymph node dissection, with some patients having no lymph nodes sampled at all. However, distant metastases were common (>50%) during follow-up in both series, even in patients with N0 disease. These data support our hypothesis that T3 N0 tumors invading the diaphragm may share the same prognosis as tumors with N2 disease. This was also found in two recently published series by the Memorial Sloan-Kettering Cancer Center ³ and by Rocco and associates ⁴ from Rome, which both reported a poor prognosis for patients with diaphragmatic T3 N0 M0 tumors. We postulate that diaphragmatic invasion is by itself a factor in poor prognosis because of the richness of diaphragmatic lymphatics that drain into mediastinal lymph nodes and also directly into the thoracic duct. ⁵ This drainage may explain the high rate of distant metastases observed during follow-up among patients with diaphragmatic invasion. Moreover, Yokoi and associates studied the survival of 40 patients with information regarding in-depth invasion of the diaphragm. Three patients, at least, of those 40 also had resection of invaded neighboring structures and shared the likelihood of invasion of both the diaphragm and other organs (chest wall, pericardium, or omentum). This makes their statistical analysis unclear because combined resection of the diaphragm and other organs worsened the prognosis of patients in their series (5-year survival 27.6% vs 0%, P = .073).

12/8/114934doi:10.1067/mtc.2001.114934

References

1. Yokoi K, Tsuchiya R, Mori T, Nagai K, Furukawa T, Fujimura S, et al. Results of surgical treatment of lung cancer involving the diaphragm. J Thorac Cardiovasc Surg 2000;120:799-805.[Abstract/Free Full Text]
   
2. Riquet M, Porte H, Chapelier A, Brichon P-Y, Bernard A, Dujon A, et al. Resection of lung cancer invading the diaphragm. J Thorac Cardiovasc Surg 2000;120:417-8.[Free Full Text]
   
3. Weksler B, Bains M, Burt M, Downey R, Martini N, Rusch V, et al. Resection of lung cancer invading the diaphragm. J Thorac Cardiovasc Surg 1997;114:500-1.[Free Full Text]
   
4. Rocco G, Rendina EA, Meroni A, Venuta F, Pona CD, Giacomo TD, et al. Prognostic factors after surgical treatment of lung cancer invading the diaphragm. Ann Thorac Surg 1999;68:2065-8.[Abstract/Free Full Text]
   
5. Riquet M, Souilamas R, Hidden G. Lymphatic drainage from the pleural aspect of the diaphragm [abstract]. Eur J Lymph 2000;31:57.
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marc Riquet Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Riquet, M. Articles by Lang-Lazdunski, L. Search for Related Content PubMed PubMed Citation Articles by Riquet, M. Articles by Lang-Lazdunski, L.