Invited Critique |

Is Palpation in the Operating Room the Best Method for Surgical Planning?

Richard J. Bold, MD
Arch Surg. 2012;147(9):875. doi:10.1001/archsurg.2012.2165.
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Surgical resection of isolated pulmonary metastatic melanoma improves overall survival in a highly select group of patients. However, the devil is in the details. By that, I mean that a critical examination of how these “selected” patients are identified needs to be made to ensure a benefit from the surgical intervention while sparing those patients with poor outcomes the complications of a thoracic operation. Peterson et al1 reported a series of more than 1700 patients with pulmonary metastasis from cutaneous melanoma; less than 20% underwent resection of the metastatic disease to the lung. From this and other studies, those patients most likely to benefit harbor solitary lesions; furthermore, incomplete resection offers minimal improvement in survival. Chua et al2 recently reported a single-institution series of 292 consecutive patients; the median survival for patients undergoing resection of a solitary melanoma metastasis was 35 months, decreasing to 21 months for 2 or 3 melanoma metastases and 10 months for more than 3 distinct lesions,2 which is not different from the median survival of 8 months for those patients who did not undergo resection of pulmonary metastatic melanoma.1 Therefore, the preoperative selection of patients is essential to identify those patients most likely to benefit from thoracic surgery and to spare an unnecessary and potentially morbid operation for those who will not benefit.

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