E-43. Most influential papers in surgery

Abstract

However, three topics have generated a particularly large amount of interest and resulted in papers which, although may not be definitive, have provided valuable insight into their respective clinical areas. These include: PET scan staging of lung cancer, defining early stage bronchioloalveolar carcinoma (BAC) and multi-modality treatment of superior sulcus tumours. The PLUS group from the Netherlands performed a randomized trial in 188 patients with presumed resectable non small cell lung cancer (NSCLC) [6]. Patients underwent a conventional metastatic work-up either with or without ‘*FDG-PET scanning. The primary endpoint was the number of futile thoracotomies, defined as recurrence or death within one year, benign lesion, pathologic stage IIIA or BIB or exploratory thoracotomy without resection. With the addition of PET scanning, futile thoracotomies declined from 41% to 21% and the percentage of patients upstaged as a result of the pre-operative work-up increased from 12% to 27%. Matsuguma and colleagues correlated the percentage of ground glass opacity (GGO) seen on high resolution CT scan with lymph node metastasis and other potential prognostic factors in 96 patients with stage 1A lung cancer [7]. Tumours showing >50% GGO were all found to be BAC with no lymph node metastasis or lymphatic invasion. These patients were more likely to be non-smoking women and none have recurred. This group may be appropriate to consider for limited resection. A single armed study of concurrent induction chemo-radiotherapy followed by surgical resection was performed in 111 patients with T3 or T4 NO-l superior sulcus NSCLC under the Intergroup Trial mechanism of the U.S. National Cancer Institute [8]. Patients received 2 cycles of cisplatin and etoposide and 45Gy of radiation. 92% had a complete resection with a 2.4% operative mortality and a 25% pathologic complete response rate. The 2 year survival is 55% overall and 70% for those who had a complete resection. All three of these studies should have a major impact on the way we practice thoracic surgical oncology in the future.