Last week we had an appt at Duke and have decided to transfer surgical and ongoing treatment to Duke which is 3.5 hours away. Thank you again for encouraging the second opinion.
On the same day and prior to surgery, the TS will perform a mediastinoscopy. If positive results then surgery will be cancelled and options discussed. I assume that frozen sections will be collected and analyzed in the op room or nearby and the proceed or cancel decision will be based on those findings. My concern is whether frozen section results have been shown to "adequately" correlate with standard path lab analyses that take extra time and follow different protocols? I understand that one of the major benefits of doing the mediastinoscopy just prior to surgery is the fact that the patient only has to undergo general anesthesia once. How does the uncertainty, if any, posed by making a decision based on frozen sections compare to the risk of an additional round of general anesthesia in the case where mediastinoscopy is done x days prior to surgery?
When I tried researching this issue I thought frozen sections are commonly used to determine margins. I was surprised to learn that this is not necessarily the case.
Currently, surgeons rely on vision and touch to detect tumors during surgery. “There is still no good way to determine a tumor’s margins,” says Shuming Nie, director of cancer nanotechnology programs at Emory’s Winship Cancer Institute. “It’s still guesswork.”
http://emoryhealthmagazine.emory.edu/issues/2012/winter/briefs/a-yellow…
The reliance on frozen sections to decide whether to proceed with a same day surgery but not to evaluate a tumor's margins during surgery is confusing to me. Am I missing something?
With utmost respect,
Lisa
Reply # - December 22, 2013, 09:24 PM
Reply To: Mediastinoscopy, Frozen Sections, Proceed or Cancel
I would say that it's very common to do same-day mediastinoscopy and rely on the frozen sections. Yes, the major advantage is the need for only one scheduled OR visit and one time under general anesthesia. I can't quote you chapter and verse about the how much the same day procedure approximates the separate procedure, but I would say that it is sufficiently close that I know of that every thoracic surgeon I've ever worked, with, including many who are very highly regarded in the field, regularly offer it for many if not most of their patients.
I'll try to get a better answer about the decision-making strategy of the best thoracic surgeons and any data to speak to the difference between same-day frozen section analysis and a full pathology report with a delay of days for a two-step procedure between mediastinoscopy and the full surgery.
-Dr. West
Reply # - December 23, 2013, 05:07 PM
Reply To: Mediastinoscopy, Frozen Sections, Proceed or Cancel
I had mine done prior to surgery and glad I did. I wouldn't want to go in thinking I was having a lobectomy only to find out due to the mediastinoscopy done at the same time, they couldn't complete my surgery. I would rather know before hand if I was able to do the lobectomy. Margins have to do with the actual lobe removal and not the lymph nodes. I had a top thoracic surgeon out of Boston. Take care, Judy