» Thoracic
» Survey Results

Approaches to surgical management after induction therapy for resectable
lung cancer.

This survey was posted during January and February, 2007.

• There were a total of 71 survey respondents, most of whom were
  from North America and Europe.
• The majority of surgeons perform resection between 2 and 6
  weeks after completion of induction therapy.
• The preferred surgical approach is a muscle sparing thoracotomy
  or a lateral thoracotomy.
• The vast majority of surgeons perform routine lymph node dissection
  or, less commonly, lymph node sampling as part of the operation.
• Most surgeons staple the bronchus, the majority preferring
  use of a stapler that does not also cut the tissue.
• Three fourths of surgeons routinely use a local tissue flap
  to cover the bronchial stump.

Assume for purposes of this survey that the patient in question
is a 60 year old man who has a peripheral T2 RUL lung squamous cell cancer for
which chemotherapy (2 cycles, platinum based) and radiation therapy (55 Gy) were
administered for biopsy-proven N2 disease.  A substantial clinical response
to the treatment has been documented. The patient is a good surgical risk from
a cardiopulmonary standpoint.

1. What is your preferred timing for surgery in this patient?   Response Percent Response Total     2-4 weeks after completion of therapy 35.2% 25     4-6 weeks after completion of therapy 59.2% 42     6-8 weeks after completion of therapy 5.6% 4 Total Respondents   71 (skipped this question)   0

2. What is your preferred approach for surgical therapy in this patient?   Response Percent Response Total     Muscle sparing thoracotomy (anterior or lateral) 38% 27     Lateral thoracotomy dividing the latissimus dorsi and sparing the serratus 50.7% 36     Posterolateral thoracotomy dividing the latissimus and rhomboids and dividing a rib or performing rib excision 7% 5     Video-assisted minimally invasive techniques 4.2% 3 Total Respondents   71 (skipped this question)   0

3. What is your standard approach to mediastinal lymph nodes in this patient?   Response Percent Response Total     No sampling/dissection necessary if the nodes appear normal 1.4% 1     Routine lymph node sampling 32.4% 23     Routine lymph node dissection 66.2% 47 Total Respondents   71 (skipped this question)   0

4. How do you close the bronchial stump in such patients?   Response Percent Response Total     Linear cutting stapler 19.7% 14     Linear stapler, cutting the bronchus distal to the staple line 74.6% 53     Hand sewn closure 5.6% 4 Total Respondents   71 (skipped this question)   0

5. Do you cover the stump after routine closure in such patients?   Response Percent Response Total     No 25.4% 18     With pericardial fat 19.7% 14     With adjacent soft tissues 19.7% 14     With muscle flap 35.2% 25 Total Respondents   71 (skipped this question)   0

6. How many lung resections do you perform annually to treat lung cancer?   Response Percent Response Total 2.8% 2     10 to 30 14.1% 10     30 to 50 42.3% 30     50 to 100 26.8% 19     More than 100 14.1% 10 Total Respondents   71 (skipped this question)   0

7. In what region is your surgical practice based?   Response Percent Response Total     North America 63.4% 45     Europe 25.4% 18     South America 2.8% 2     Asia 7% 5     Africa 1.4% 1 Total Respondents   71 (skipped this question)   0