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Jens Eckardt, MD; Peter Bjørn Licht, MD, PhD
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From the Department of Cardiothoracic Surgery, Odense University Hospital.

Correspondence to: Jens Eckardt, MD, Department of Cardiothoracic Surgery, Odense University Hospital, Sdr Blvd 29, Odense, DK-5000 Denmark; e-mail: jens.eckardt@rsyd.dk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts: Dr Licht has received research and travel grants and speakers honoraria from Ethicon Endo-surgery, Inc, whose product is mentioned in this article. Dr Eckardt has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1837. doi:10.1378/chest.13-0579
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To the Editor:

Drs Liu and Liu raise a concern about open pulmonary metastasectomy in their letter regarding our recent article in CHEST (December 2012).1 They argue that video-assisted thoracoscopic surgery (VATS) is preferable over thoracotomy because it is less invasive—an assumption which is shared by most thoracic surgeons even though the evidence base for this assumption is low.2

Drs Liu and Liu raise an important question for which there is no answer in the existing literature, including our article: namely, whether recurrence rates after metastasectomy can be reduced by a more radical resection during thoracotomy compared with VATS. The authors argue that factors such as efficacy, invasiveness, compliance, and preservation of quality of life should be taken into consideration when planning pulmonary metastasectomy, a belief which is spreading in the thoracic community3 but which is also against current recommendations.4

In our article, which is the first, to our knowledge, observer-blinded study investigating VATS vs open metastasectomy, we demonstrated that even in the 21st century, in a high-volume VATS center that uses modern surgical technology, metastatic disease is not completely removed when manual palpation is restricted by the port holes. Whether survival rates or recurrence rates are different between thoracotomy and (repeated) VATS procedures is currently unknown, and we certainly agree with Drs Liu and Liu that more prospective trials are needed. We urge the thoracic surgical community to launch large prospective randomized multicenter trials on this topic.

References

Eckardt J, Licht PB. Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest. 2012;142(6):1598-1602. [CrossRef] [PubMed]
 
Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27(15):2553-2562. [CrossRef] [PubMed]
 
Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T; ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2008;3(11):1257-1266. [CrossRef] [PubMed]
 
Molnar TF, Gebitekin C, Turna A. What are the considerations in the surgical approach in pulmonary metastasectomy? J Thorac Oncol. 2010;5(6 suppl 2):S140-S144. [CrossRef] [PubMed]
 

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Tables

References

Eckardt J, Licht PB. Thoracoscopic versus open pulmonary metastasectomy: a prospective, sequentially controlled study. Chest. 2012;142(6):1598-1602. [CrossRef] [PubMed]
 
Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27(15):2553-2562. [CrossRef] [PubMed]
 
Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T; ESTS Pulmonary Metastasectomy Working Group. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2008;3(11):1257-1266. [CrossRef] [PubMed]
 
Molnar TF, Gebitekin C, Turna A. What are the considerations in the surgical approach in pulmonary metastasectomy? J Thorac Oncol. 2010;5(6 suppl 2):S140-S144. [CrossRef] [PubMed]
 
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