Should lobectomy patients with microscopic involvement of the bronchial resection margin undergo re-operation to improve their long-term survival?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether re-operative surgery or radiotherapy should be given to patients with residual microscopic tumour at the bronchial resection margin. Altogether 427 papers were identified using the reported search of which 13 represented the best evidence on this topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that for patients with stage I-II tumours who could easily tolerate re-operation, further resection is an acceptable treatment option and may improve survival. However, only 4 of the 13 studies that we identified recommend this strategy. In addition, there is no convincing evidence that radiotherapy significantly improves survival for patients not selected for re-operation.
Department of Cardiothoracic Surgery, Blackpool Victoria Infirmary, Blackpool, UK.
Sankar
S
Balasubramanian
John
J
Au
Joel
J
Dunning