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Article: Operating on a suspicious lung mass without a preoperative tissue diagnosis: Pros and cons

TitleOperating on a suspicious lung mass without a preoperative tissue diagnosis: Pros and cons
Authors
Issue Date2013
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/ejcts
Citation
European Journal of Cardio-thoracic Surgery, 2013, v. 44 n. 2, p. 231-237 How to Cite?
AbstractObjectives: Patients with a suspicious lung mass sometimes receive surgery with no preoperative tissue diagnosis despite-and sometimes in lieu of-modern medical investigations. The pros and cons of doing so have rarely been studied. Methods: Pulmonary surgery was performed in 443 consecutive adult patients with a lung mass confirmed or suspected to be an early stage primary lung cancer. No diagnosis was confirmed preoperatively in 206 (46.5%) patients. Whether to take a core biopsy or wedge excision biopsy for frozen section assessment intraoperatively was decided at the surgeon's discretion. Results: Patients without preoperative diagnosis were on average younger than those with a diagnosis (61 vs 66 years, P < 0.01), but were otherwise similar to those who had a preoperative diagnosis confirmed. In all patients operated on without a preoperative diagnosis, there was no mortality or major complication, and the perioperative minor morbidity rate was 9.7%. Among patients ultimately found to have lung cancer and who received a lobectomy, performing a frozen section intraoperatively did not increase mean operation time or morbidity. Among those patients with no preoperative tissue diagnosis, 97 (47.1%) proceeded to surgery without attempts at preoperative diagnosis, and 109 (52.9%), after attempts at preoperative diagnosis failed to yield a positive diagnosis. After surgery, benign disease was found in 16 (7.8%) patients without preoperative diagnosis. A significantly lower proportion of patients without preoperative diagnosis waited an interval of over 28 days between presentation and being accepted for thoracic surgery (42.2 vs 54.9%, P < 0.01). However, they were not more likely to have Stage I disease and did not have better recurrence-free survival rates on survival analysis. Conclusions: Proceeding to surgery without preoperative diagnosis in selected patients with a suspicious lung mass is safe and can potentially reduce the interval between presentation and surgical management. However, the shortened workup time is not associated with improved surgical or oncological outcomes. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/196722
ISSN
2015 Impact Factor: 2.803
2015 SCImago Journal Rankings: 1.568
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorSihoe, ADL-
dc.contributor.authorHiranandani, R-
dc.contributor.authorWong, H-
dc.contributor.authorYeung, ESL-
dc.date.accessioned2014-04-24T02:10:36Z-
dc.date.available2014-04-24T02:10:36Z-
dc.date.issued2013-
dc.identifier.citationEuropean Journal of Cardio-thoracic Surgery, 2013, v. 44 n. 2, p. 231-237-
dc.identifier.issn1010-7940-
dc.identifier.urihttp://hdl.handle.net/10722/196722-
dc.description.abstractObjectives: Patients with a suspicious lung mass sometimes receive surgery with no preoperative tissue diagnosis despite-and sometimes in lieu of-modern medical investigations. The pros and cons of doing so have rarely been studied. Methods: Pulmonary surgery was performed in 443 consecutive adult patients with a lung mass confirmed or suspected to be an early stage primary lung cancer. No diagnosis was confirmed preoperatively in 206 (46.5%) patients. Whether to take a core biopsy or wedge excision biopsy for frozen section assessment intraoperatively was decided at the surgeon's discretion. Results: Patients without preoperative diagnosis were on average younger than those with a diagnosis (61 vs 66 years, P < 0.01), but were otherwise similar to those who had a preoperative diagnosis confirmed. In all patients operated on without a preoperative diagnosis, there was no mortality or major complication, and the perioperative minor morbidity rate was 9.7%. Among patients ultimately found to have lung cancer and who received a lobectomy, performing a frozen section intraoperatively did not increase mean operation time or morbidity. Among those patients with no preoperative tissue diagnosis, 97 (47.1%) proceeded to surgery without attempts at preoperative diagnosis, and 109 (52.9%), after attempts at preoperative diagnosis failed to yield a positive diagnosis. After surgery, benign disease was found in 16 (7.8%) patients without preoperative diagnosis. A significantly lower proportion of patients without preoperative diagnosis waited an interval of over 28 days between presentation and being accepted for thoracic surgery (42.2 vs 54.9%, P < 0.01). However, they were not more likely to have Stage I disease and did not have better recurrence-free survival rates on survival analysis. Conclusions: Proceeding to surgery without preoperative diagnosis in selected patients with a suspicious lung mass is safe and can potentially reduce the interval between presentation and surgical management. However, the shortened workup time is not associated with improved surgical or oncological outcomes. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.-
dc.languageeng-
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/ejcts-
dc.relation.ispartofEuropean Journal of Cardio-thoracic Surgery-
dc.titleOperating on a suspicious lung mass without a preoperative tissue diagnosis: Pros and cons-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/ejcts/ezs671-
dc.identifier.pmid23299236-
dc.identifier.scopuseid_2-s2.0-84880679416-
dc.identifier.hkuros247058-
dc.identifier.volume44-
dc.identifier.issue2-
dc.identifier.spage231-
dc.identifier.epage237-
dc.identifier.isiWOS:000321828300021-

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