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L. Toufektzian et al. / Interactive CardioVascular and Thoracic Surgery
[10] Trousse D, Barlesi F, Loundou A, Tasei AM, Doddoli C, Giudicelli R et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007;133:1193–200. [11] van Rens MT, Zanen P, Brutel de La Rivière A, Elbers HR, van Swieten HA, van Den Bosch JM. Survival in synchronous vs. single lung cancer: upstaging better reflects prognosis. Chest 2000;118:952–8. [12] Kocaturk CI, Gunluoglu MZ, Cansever L, Demir A, Cinar U, Dincer SI et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg 2011;39:160–6. [13] Jung EJ, Lee JH, Jeon K, Koh WJ, Suh GY, Chung MP et al. Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer. Lung Cancer 2011;73:237–42. [14] Rostad H, Strand TE, Naalsund A, Norstein J. Resected synchronous primary malignant lung tumors: a population-based study. Ann Thorac Surg 2008;85:204–9. [15] Tanvetyanon T, Robinson L, Sommers KE, Haura E, Kim J, Altiok S et al. Relationship between tumor size and survival among patients with resection of multiple synchronous lung cancers. J Thorac Oncol 2010;5: 1018–24.
eComment. Does the histological features of synchronous multiple primary lung cancers influence the surgical planning in patients undergoing curative surgery?
proven as squamous cell carcinoma. Although we concur with the conclusion of Toufektzian and colleagues, who recommend bilateral anatomical lung resections (pneumonectomy excluded) only in those cases where there are no concerns about postoperative pulmonary reserve, we wish to better define (and distinguish) such a challenging strategy of care according to the histology of synchronous multiple primary lung cancers. As already suggested by ourselves [2], the International Association for the Study of Lung Cancer (IASLC) has recently issued a revised adenocarcinoma classification [3], reclassifying the entire category of pulmonary adenocarcinomas into three categories (adenocarcinoma in situ [AIS], minimally invasive adenocarcinoma [MIA] and invasive adenocarcinomas [IA]) with several surgical implications. Indeed, as remarked in detail by Van Schil et al. [4], the "early-stages" AIS and MIA should have a disease-specific survival of 100% or near 100% after sublobar resection and mediastinal sampling, respectively. To simplify, we may assume that this new classification should be take in mind when planning the best surgical strategy in second primary NSCLCs. Therefore, the decision of performing a sublobar resection instead of standard anatomical resection in patients with adenocarcinoma should be based (in the forthcoming future) not only on clinical considerations (parenchymal-sparing strategy when a bilateral resection is previewed) but also on histological features (and the oncological implications related to them). Unfortunately, detailed preoperative histological features are not always achievable in daily clinical practice, a fact that substantially limits the clinical impact of such considerations. In conclusion, the histological features of synchronous multiple primary lung cancers represent relevant information when planning the best surgical management. The authors’ reflections and reactions on the points raised would be greatly appreciated. Conflict of interest: none declared.
Authors: Filippo Lococo1, Giovanni Leuzzi2, Cristian Rapicetta1 and Alfredo Cesario3 1 Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy 2 Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy 3 Scientific Direction, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy doi: 10.1093/icvts/ivu352 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. The best therapeutic strategy for synchronous/metachronous primary non-small cell lung cancers (NSCLCs) remains up for discussion in the scientific community, especially regarding the surgical approach. In this setting, we have read with great interest the recent article by Toufektzian and co-workers [1], who have reviewed the pertinent literature with the aim of clarifying whether the extent of pulmonary resection substantially affects survival in patients with synchronous multiple primary lung cancers undergoing curative surgery. In the clinical scenario, the patient was affected by a synchronous lung cancer with only one (right upper lesion) pathologically
References [1] Toufektzian L, Attia R, Veres L. Does the extent of resection affect survival in patients with synchronous multiple primary lung cancers undergoing curative surgery? Interact CardioVasc Thorac Surg 2014;19:1059–64. [2] Lococo F, Cesario A, Leuzzi G, Apolone G. Second primary non-small-cell lung cancer: implications of the new adenocarcinoma classification in the challenging decision of the best surgical strategy. Eur J Cardiothorac Surg 2014;45:1115–6. [3] Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244–85. [4] Van Schil PE, Asamura H, Rusch VW, Mitsudomi T, Tsuboi M, Brambilla E et al. Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification. Eur Respir J 2012;39:478–86.
L. Toufektzian et al. / Interactive CardioVascular and Thoracic Surgery
[10] Trousse D, Barlesi F, Loundou A, Tasei AM, Doddoli C, Giudicelli R et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg 2007;133:1193–200. [11] van Rens MT, Zanen P, Brutel de La Rivière A, Elbers HR, van Swieten HA, van Den Bosch JM. Survival in synchronous vs. single lung cancer: upstaging better reflects prognosis. Chest 2000;118:952–8. [12] Kocaturk CI, Gunluoglu MZ, Cansever L, Demir A, Cinar U, Dincer SI et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg 2011;39:160–6. [13] Jung EJ, Lee JH, Jeon K, Koh WJ, Suh GY, Chung MP et al. Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer. Lung Cancer 2011;73:237–42. [14] Rostad H, Strand TE, Naalsund A, Norstein J. Resected synchronous primary malignant lung tumors: a population-based study. Ann Thorac Surg 2008;85:204–9. [15] Tanvetyanon T, Robinson L, Sommers KE, Haura E, Kim J, Altiok S et al. Relationship between tumor size and survival among patients with resection of multiple synchronous lung cancers. J Thorac Oncol 2010;5: 1018–24.
eComment. Does the histological features of synchronous multiple primary lung cancers influence the surgical planning in patients undergoing curative surgery?
proven as squamous cell carcinoma. Although we concur with the conclusion of Toufektzian and colleagues, who recommend bilateral anatomical lung resections (pneumonectomy excluded) only in those cases where there are no concerns about postoperative pulmonary reserve, we wish to better define (and distinguish) such a challenging strategy of care according to the histology of synchronous multiple primary lung cancers. As already suggested by ourselves [2], the International Association for the Study of Lung Cancer (IASLC) has recently issued a revised adenocarcinoma classification [3], reclassifying the entire category of pulmonary adenocarcinomas into three categories (adenocarcinoma in situ [AIS], minimally invasive adenocarcinoma [MIA] and invasive adenocarcinomas [IA]) with several surgical implications. Indeed, as remarked in detail by Van Schil et al. [4], the "early-stages" AIS and MIA should have a disease-specific survival of 100% or near 100% after sublobar resection and mediastinal sampling, respectively. To simplify, we may assume that this new classification should be take in mind when planning the best surgical strategy in second primary NSCLCs. Therefore, the decision of performing a sublobar resection instead of standard anatomical resection in patients with adenocarcinoma should be based (in the forthcoming future) not only on clinical considerations (parenchymal-sparing strategy when a bilateral resection is previewed) but also on histological features (and the oncological implications related to them). Unfortunately, detailed preoperative histological features are not always achievable in daily clinical practice, a fact that substantially limits the clinical impact of such considerations. In conclusion, the histological features of synchronous multiple primary lung cancers represent relevant information when planning the best surgical management. The authors’ reflections and reactions on the points raised would be greatly appreciated. Conflict of interest: none declared.
Authors: Filippo Lococo1, Giovanni Leuzzi2, Cristian Rapicetta1 and Alfredo Cesario3 1 Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy 2 Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute - IFO, Rome, Italy 3 Scientific Direction, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy doi: 10.1093/icvts/ivu352 © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. The best therapeutic strategy for synchronous/metachronous primary non-small cell lung cancers (NSCLCs) remains up for discussion in the scientific community, especially regarding the surgical approach. In this setting, we have read with great interest the recent article by Toufektzian and co-workers [1], who have reviewed the pertinent literature with the aim of clarifying whether the extent of pulmonary resection substantially affects survival in patients with synchronous multiple primary lung cancers undergoing curative surgery. In the clinical scenario, the patient was affected by a synchronous lung cancer with only one (right upper lesion) pathologically
References [1] Toufektzian L, Attia R, Veres L. Does the extent of resection affect survival in patients with synchronous multiple primary lung cancers undergoing curative surgery? Interact CardioVasc Thorac Surg 2014;19:1059–64. [2] Lococo F, Cesario A, Leuzzi G, Apolone G. Second primary non-small-cell lung cancer: implications of the new adenocarcinoma classification in the challenging decision of the best surgical strategy. Eur J Cardiothorac Surg 2014;45:1115–6. [3] Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger K, Yatabe Y et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244–85. [4] Van Schil PE, Asamura H, Rusch VW, Mitsudomi T, Tsuboi M, Brambilla E et al. Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification. Eur Respir J 2012;39:478–86.
