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• W2066936504 abstract "We read with interest Vicidomini and colleagues’ [1Vicidomini G. Santini M. Fiorello A. Parascandolo V. Calabro B. Pastore V. Intraoperative pleural lavage is it a valid prognostic factor in lung cancer?.Ann Thorac Surg. 2005; 79: 254-257Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar] article on the importance of intraoperative pleural lavage cytology as a prognostic factor in nonsmall cell lung cancer (NSCLC). This study corroborates the results of previous studies [2Buhr J. Berghauser K.H. Gonner S. Kelm C. Burkhardt E.A. Padberg W.M. The prognostic significance of tumor cell detection in intraoperative pleural lavage and lung tissue cultures for patients with lung cancer.J Thorac Cardiovasc Surg. 1997; 113: 683-690Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 3Okada M. Tsubota N. Yoshimura M. Miyamoto Y. Maniwa Y. Role of pleural lavage cytology before resection for primary lung carcinoma.Ann Surg. 1999; 229: 579-584Crossref PubMed Scopus (52) Google Scholar] on the topic in identifying positive pleural lavage cytology (PLC) as an independent prognostic factor in patients with NSCLC. We agree with the authors that it has been shown to be an important and probably independent prognostic factor. However, to conclude that these patients have to be considered to have “subclinical malignant pleural effusion and classified as T4 disease” seems erroneous. This conclusion would be untenable unless it is proven in large studies that patients with positive pleural lavage cytology (with otherwise localized operable disease) have a prognosis similar to other T4 patients. Classifying a tumor as T4 disease automatically changes the intent of treatment from potentially curative to palliative, and this cannot be done on relatively flimsy evidence. The authors go on to recommend that “ potential objective [of pleural lavage cytology] is to exclude patients form useless surgery.” This again is unacceptable as in the authors’ own series, the 3-year survival of these patients is 30%, which would not be expected with other T4 tumors. Although the difference in 3-year survival between patients without and with positive PLC (65% and 30%, respectively) appears significant, a matched pair analysis (with patients matched for T and N stages) would give a more accurate estimation of the importance of pleural lavage cytology. To summarize, we strongly believe that although PLC may be an important prognostic factor for survival in NSCLC, current evidence is not strong enough to classify them as T4 tumors, and this denies a potentially curative treatment for these patients. Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer: ReplyThe Annals of Thoracic SurgeryVol. 80Issue 4PreviewWe thank Dr P ramesh and associates [1] for their valuable remarks and interest in our work [2]. The article reported the results of our initial experience with intraoperative pleural lavage in 84 patients undergoing major lung resection for nonsmall cell lung cancer. Our results confirm those of other authors and suggest that pre-resectional pleural lavage is able to detect patients with a high risk of recurrences after lung resection. The statistical analysis showed a significant difference in survival between patients with positive and patients with negative pleural lavage cytology (PLC) (p = 0.025). Full-Text PDF" @default.
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• W2066936504 date "2005-10-01" @default.
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• W2066936504 title "Intraoperative Pleural Lavage Cytology Should Not Influence Decision for Radical Surgery in Nonsmall Cell Lung Cancer" @default.
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• W2066936504 doi "https://doi.org/10.1016/j.athoracsur.2005.01.039" @default.
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