Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1992 Jan;47(1):3–5. doi: 10.1136/thx.47.1.3

The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer.

G M Tsang 1, D C Watson 1
PMCID: PMC463535  PMID: 1311463

Abstract

BACKGROUND: The treatment and prognosis of non-small cell lung cancer, and assessment of the results of treatment, depend on accurate perioperative staging. The extent to which this is carried out in the United Kingdom is unknown. METHODS: A postal questionnaire survey was undertaken in 1990 to determine the perioperative staging practices of cardiothoracic surgeons in the United Kingdom. RESULTS: Replies from 77 surgeons, who between them performed about 4833 pulmonary resections a year for lung cancer, were analysed. Forty four per cent of surgeons, operating on 43% of the patients, do not perform computed tomography of the thorax or mediastinal exploration before surgery. They may therefore embark on a thoracotomy for stage III disease. At thoracotomy 45% of surgeons, operating on 40% of patients, do not sample macroscopically normal lymph nodes. They may therefore understage cases as N0/N1 when there is at least microscopic disease in mediastinal lymph nodes. CONCLUSIONS: The staging of lung cancer in the United Kingdom in 1990 appears in many instances to be inadequate. There should be a more organised approach to perioperative staging so that prognosis may be assessed and comparisons between groups of patients can be made.

Full text

PDF
3

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Backer C. L., Shields T. W., Lockhart C. G., Vogelzang R., LoCicero J., 3rd Selective preoperative evaluation for possible N2 disease in carcinoma of the lung. J Thorac Cardiovasc Surg. 1987 Mar;93(3):337–343. [PubMed] [Google Scholar]
  2. Choi N. C., Grillo H. C., Gardiello M., Scannell J. G., Wilkins E. W., Jr Basis for new strategies in postoperative radiotherapy of bronchogenic carcinoma. Int J Radiat Oncol Biol Phys. 1980 Jan;6(1):31–35. doi: 10.1016/0360-3016(80)90199-6. [DOI] [PubMed] [Google Scholar]
  3. Coughlin M., Deslauriers J., Beaulieu M., Fournier B., Piraux M., Rouleau J., Tardif A. Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer. Ann Thorac Surg. 1985 Dec;40(6):556–560. doi: 10.1016/s0003-4975(10)60348-7. [DOI] [PubMed] [Google Scholar]
  4. Deneffe G., Lacquet L. M., Verbeken E., Vermaut G. Surgical treatment of bronchogenic carcinoma: a retrospective study of 720 thoracotomies. Ann Thorac Surg. 1988 Apr;45(4):380–383. doi: 10.1016/s0003-4975(98)90009-1. [DOI] [PubMed] [Google Scholar]
  5. Doby T. A tribute to Sven-Ivar Seldinger. AJR Am J Roentgenol. 1984 Jan;142(1):1–4. doi: 10.2214/ajr.142.1.1. [DOI] [PubMed] [Google Scholar]
  6. Enstrom J. E., Austin D. F. Interpreting cancer survival rates. Science. 1977 Mar 4;195(4281):847–851. doi: 10.1126/science.841309. [DOI] [PubMed] [Google Scholar]
  7. Freise G., Gabler A., Liebig S. Bronchial carcinoma and long-term survival. Retrospective study of 433 patients who underwent resection. Thorax. 1978 Apr;33(2):228–234. doi: 10.1136/thx.33.2.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Humphrey E. W., Smart C. R., Winchester D. P., Steele G. D., Jr, Yarbro J. W., Chu K. C., Triolo H. H. National survey of the pattern of care for carcinoma of the lung. J Thorac Cardiovasc Surg. 1990 Dec;100(6):837–843. [PubMed] [Google Scholar]
  9. Luke W. P., Pearson F. G., Todd T. R., Patterson G. A., Cooper J. D. Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung. J Thorac Cardiovasc Surg. 1986 Jan;91(1):53–56. [PubMed] [Google Scholar]
  10. Luke W. P., Pearson F. G., Todd T. R., Patterson G. A., Cooper J. D. Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung. J Thorac Cardiovasc Surg. 1986 Jan;91(1):53–56. [PubMed] [Google Scholar]
  11. Martini N., Flehinger B. J., Zaman M. B., Beattie E. J., Jr Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Surg. 1983 Sep;198(3):386–397. doi: 10.1097/00000658-198309000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mountain C. F., Lukeman J. M., Hammar S. P., Chamberlain D. W., Coulson W. F., Page D. L., Victor T. A., Weiland L. H. Lung cancer classification: the relationship of disease extent and cell type to survival in a clinical trials population. J Surg Oncol. 1987 Jul;35(3):147–156. doi: 10.1002/jso.2930350302. [DOI] [PubMed] [Google Scholar]
  13. Naruke T., Goya T., Tsuchiya R., Suemasu K. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg. 1988 Dec;46(6):603–610. doi: 10.1016/s0003-4975(10)64717-0. [DOI] [PubMed] [Google Scholar]
  14. Osborne D. R., Korobkin M., Ravin C. E., Putman C. E., Wolfe W. G., Sealy W. C., Young W. G., Breiman R., Heaston D., Ram P. Comparison of plain radiography, conventional tomography, and computed tomography in detecting intrathoracic lymph node metastases from lung carcinoma. Radiology. 1982 Jan;142(1):157–161. doi: 10.1148/radiology.142.1.7053525. [DOI] [PubMed] [Google Scholar]
  15. Pearlberg J. L., Sandler M. A., Beute G. H., Madrazo B. L. T1N0M0 bronchogenic carcinoma: assessment by CT. Radiology. 1985 Oct;157(1):187–190. doi: 10.1148/radiology.157.1.4034964. [DOI] [PubMed] [Google Scholar]
  16. Pearson F. G., DeLarue N. C., Ilves R., Todd T. R., Cooper J. D. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg. 1982 Jan;83(1):1–11. [PubMed] [Google Scholar]
  17. Pearson F. G. Use of mediastinoscopy in selection of patients for lung cancer operations. Ann Thorac Surg. 1980 Sep;30(3):205–207. doi: 10.1016/s0003-4975(10)61245-3. [DOI] [PubMed] [Google Scholar]
  18. Rea H. H., Shevland J. E., House A. J. Accuracy of computed tomographic scanning in assessment of the mediastinum in bronchial carcinoma. J Thorac Cardiovasc Surg. 1981 Jun;81(6):825–829. [PubMed] [Google Scholar]
  19. Richey H. M., Matthews J. I., Helsel R. A., Cable H. Thoracic CT scanning in the staging of bronchogenic carcinoma. Chest. 1984 Feb;85(2):218–221. doi: 10.1378/chest.85.2.218. [DOI] [PubMed] [Google Scholar]
  20. Whitcomb M. E., Barham E., Goldman A. L., Green D. C. Indications for mediastinoscopy in bronchogenic carcinoma. Am Rev Respir Dis. 1976 Feb;113(2):189–195. doi: 10.1164/arrd.1976.113.2.189. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES