Erschienen in:
01.12.2003 | Letters to the Editor
Reply (DOI: 10.1007/s00268-003-1025-3)
verfasst von:
Riad N. Younes, M.D., Ph.D.
Erschienen in:
World Journal of Surgery
|
Ausgabe 12/2003
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Excerpt
We thank Dr. Blakely for his interesting and important comments. According to the data in our study, of the patients presenting with unilateral lung metastases, and therefore submitted to unilateral thoracotomy, very few had a recurrence in the contralateral lung during the six-month and twelve-month follow-up periods. In fact, only 5% of those followed for 6 months and 11% of those followed for 12 months presented with pulmonary metastases in the contralateral lung (not explored in the first surgical procedure). The data showed that the indication for immediate bilateral thoracotomy is questionable in this patient population. Our study was not designed to compare unilateral versus bilateral thoracotomy (it was not a randomized study). We agree with Dr Blakely that a prospective randomized trial would show more adequately whether there is any survival benefit in submitting patients with unilateral nodules to bilateral exploration. This issue is even more relevant for patients with osteosarcoma and multiple lung metastases, as shown by multivariate analysis in our study, and should be evaluated in greater detail. Computerized tomography (CT) continues to be the standard imaging technique for evaluating pulmonary nodules; yet, even with modern equipment, the number of nodules encountered during operation is higher than the number described preoperatively. However, many such undetected nodules are inflammatory, especially in our country. …