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- Publisher Website: 10.1093/ejcts/ezs671
- Scopus: eid_2-s2.0-84880679416
- PMID: 23299236
- WOS: WOS:000321828300021
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Article: Operating on a suspicious lung mass without a preoperative tissue diagnosis: Pros and cons
Title | Operating on a suspicious lung mass without a preoperative tissue diagnosis: Pros and cons |
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Authors | |
Keywords | Lung cancer Lung cancer diagnosis Lung cancer surgery Minimally invasive surgery Solitary pulmonary nodule |
Issue Date | 2013 |
Publisher | Elsevier 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? |
Abstract | Objectives: 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 Identifier | http://hdl.handle.net/10722/196722 |
ISSN | 2023 Impact Factor: 3.1 2023 SCImago Journal Rankings: 0.974 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Sihoe, ADL | - |
dc.contributor.author | Hiranandani, R | - |
dc.contributor.author | Wong, H | - |
dc.contributor.author | Yeung, ESL | - |
dc.date.accessioned | 2014-04-24T02:10:36Z | - |
dc.date.available | 2014-04-24T02:10:36Z | - |
dc.date.issued | 2013 | - |
dc.identifier.citation | European Journal of Cardio-thoracic Surgery, 2013, v. 44 n. 2, p. 231-237 | - |
dc.identifier.issn | 1010-7940 | - |
dc.identifier.uri | http://hdl.handle.net/10722/196722 | - |
dc.description.abstract | Objectives: 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.language | eng | - |
dc.publisher | Elsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/ejcts | - |
dc.relation.ispartof | European Journal of Cardio-thoracic Surgery | - |
dc.subject | Lung cancer | - |
dc.subject | Lung cancer diagnosis | - |
dc.subject | Lung cancer surgery | - |
dc.subject | Minimally invasive surgery | - |
dc.subject | Solitary pulmonary nodule | - |
dc.title | Operating on a suspicious lung mass without a preoperative tissue diagnosis: Pros and cons | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1093/ejcts/ezs671 | - |
dc.identifier.pmid | 23299236 | - |
dc.identifier.scopus | eid_2-s2.0-84880679416 | - |
dc.identifier.hkuros | 247058 | - |
dc.identifier.volume | 44 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 231 | - |
dc.identifier.epage | 237 | - |
dc.identifier.isi | WOS:000321828300021 | - |
dc.identifier.issnl | 1010-7940 | - |