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eComment: Therapeutic options for bronchial stump infiltration following lung cancer surgery

Department of Thoracic Surgery, Theagenio Cancer Hospital, A. Simeonidi 2, 54007 Thessaloniki, Greece

Bronchial stump infiltration after lung cancer surgery. Retrospective study of a series of 2994 patients

We read with great interest Fernandez and colleagues' retrospective study concerning bronchial stump infiltration following lung cancer surgery [1].

It is well known in the international literature that microscopic residual disease at the bronchial resection margin, affects prognosis negatively and increases the risk of both locoregional and distant recurrence [2]. Our institute's experience with the disease could be summarized in the following points:

1. Routine frozen examination of the bronchial resection margin, although there are limitations, has to be common practice.
   
2. Patients with carcinoma in situ or mucosal or peribronchial microscopic residual disease and pN0/pN1 have to undergo reoperation (if this is anatomically and functionally feasible). When reoperation is not feasible we consider adjuvant chemotherapy.
   
3. Patients with mucosal or peribronchial microscopic residual disease and pN2 are eligible for chemotherapy and mediastinal irradiation.
   

The literature only comprises retrospective studies collected over many years. There is no evidence available concerning adjuvant chemoradiotherapy in patients with a R1 resection of the bronchial resection margin and probably in the future this question will not be evidenced as the use of adjuvant chemotherapy after radical resection will increase. Large multicenter studies are needed for determining therapeutical and prognostic points.

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1. Fernández E, López de Castro P, Astudillo J, Fernández-Llamazares J. Bronchial stump infiltration after lung cancer surgery. Retrospective study of a series of 2994 patients. Interact CardioVasc Thorac Surg 2009;9:182–186.[Abstract/Free Full Text]
2. Wind J, Smit E, Senan S, Eerenberg JP. Residual disease at the bronchial stump after curative resection for lung cancer. Eur J Cardiothorac Surg 2007;32:29–34.[Abstract/Free Full Text]

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): Nikolaos Barbetakis Permission Requests Google Scholar Articles by Barbetakis, N. Articles by Tsilikas, C. PubMed PubMed Citation Articles by Barbetakis, N. Articles by Tsilikas, C. Related Collections Related Article