Sleeve lobectomy. Is it valid for all cases of lung cancer?

1. T he first sleeve lobectomy for a bronchogenic carcinoma was done in 1952 and not 1954 as mentioned by Allison [2—4]. 2. It was mentioned that bone scanning was performed in symptomatic patients or in patients with abnormal blood work which may lead to many missed metastatic bone lesions. 3. T hey discussed that surgicopathologic staging was performed according to the New International Staging System for Lung Cancer (International Union Against Cancer, 1997) [1]. I would like to get clarification on the old cases which were collected since 1981 and their method for staging. Was the staging based on the recent or older cases? 4. A mong the cases of this study, there were five patients who had a history of lobectomy for contralateral lung cancer [1]. Was the new ipsilateral lung cancer metastatic lung cancer or second primary? 5. O ne of the stage I patients had a synchronous contralateral stage II lung cancer for which a lobectomy was performed 6 weeks later [1]. I wonder if this patient should have been scheduled as stage I, or transferred to stage IV as the contralateral lung cancer should be considered as distant metastasis [5]. 6. B ecause closing the main bronchus ostium at the level of the carina produces excessive suture tension, the sleeve lobectomy performed in these 15 patients can be considered an alternative to sleeve pneumonectomy [1]. A more detailed explanation is needed as I didn’t know if the anastomosis had been done to the carina, or if the right carina was closed then another opening at the tracheobronchial junction was used for the anastomosis with the bronchus intermedius. As we know, sleeve pneumonectomy depends on total excision of the carina with the removed lung and reanastomosis of the trachea to the main bronchus of the remaining lung. 7. R esection was incomplete in nine (4.1%) patients in whom frozen sections of the bronchial margin were positive but pneumonectomy was contraindicated by the results of preoperative investigations [1]. These patients with contraindication for pneumonectomy regarding the pulmonary functions or any other causes were in need of other modalities such as neoadjuvant therapy or multimodality therapy. I do not think the decision for surgery in these patients was right from the start. The collected risk factors in that article [1] are supportingmyopinion as therewas no improvement of survival in advanced stages even with sleeve surgery. Therefore it is wise to have the other lines of management instead of exposing the patient to the risk of surgery and repair of positive margins.