Caecilia Ng

On the Article “Nodal Upstaging Is More Common with Thoracotomy Than with VATS during Lobectomy for Early-Stage Lung Cancer: An Analysis from the National Cancer Data Base” by Medbery et al.

To the Editor: We have read with great interest the manuscript by Medbery et al. on nodal upstaging during lobectomy for early-stage lung cancer. According to the authors nodal upstaging was more common with thoracotomy than with video-assisted thoracoscopic surgery (VATS). This analysis of data extracted from the National Cancer Data Base truly provides a realistic picture of daily thoracic surgery practice in the United States. We would like to comment on important factors that might have confounded nodal upstaging in this analysis. As already mentioned by the authors, central versus peripheral tumor location might be an important cofactor for upstaging in clinically nodal-negative patients. This has recently been demonstrated by Decaluwé et al. in a single-center analysis in which the risk for upstaging was more dependent on tumor localization than on the surgical approach. Tumor localization is the most important factor guiding the decision regarding a surgical approach. Thus, we suspect that in centrally located tumors requiring complex procedures, open surgery was preferred. It is obvious, that with increasing VATS experience, centers expand the indication for a minimally invasive approach. With a higher prevalence of VATS resections including more centrally located tumors, we would expect more nodal upstaging. This argument is

Benefits of a multidisciplinary team approach on a challenging case of bilateral tension pneumothorax

This editorial comment refers to the article “ Multidisciplinary team approach on a case of bilateral tension pneumothorax ” by Li et al ., Journal of Thoracic Disease ( JTD ); Vol. 10, No. 4 (1).