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Staged axillary thoracotomy for bilateral lung metastases: an effective and minimally invasive approach
S Margaritora1, A Cesario, D Galetta
1General Thoracic Surgery, Catholic University of Rome (Divisione di Chirurgia Toracica, Università Cattolica del Sacro Cuore), Italy. stemargaritora@yahoo.com
Objective:
We describe our experience with the staged axillary thoracotomy (SAT), for the treatment of bilateral lung metastases.
Materials And Methods:
Between January 1995 and June 1998, 75 lung metastasectomies were carried out in our institution, 49 (65%) monolateral, and 26 (35%) bilateral. In the latter group of patients we adopted a staged axillary thoracotomy.
Results:
All wedge resections and two lobectomies (1 LUL and 1 RLL) were performed through this approach. Resection has been complete in all patients. Histology was epithelial in 15 (57%), sarcoma in nine (35%) and germ cell in two (8%). Two to three metastases have been resected in 10 patients (38%); four to 10 in 12 patients (46%) and over 10 in four patients (15%). The radiological pre-operative assessment was accurate in 15 patients (57%), underestimated in nine (35%) and overestimated in two (8%). The average interval between the two procedures has been 24 +/- 6 days. The average operation duration time was 50 min (range 36-67). We do not report any post-operative death or major complication. The average hospitalization was 3.2 days (range 2-6) for each single procedure and 6.2 days (range 4-10) for both procedures.
Conclusion:
This technique is adequate, fast and safe and did not affect the shoulder girdle motion at all providing an excellent cosmetic outcome. The operative trauma is limited and a minor post-operative pain is present. A shortening of the interval between the two operations is allowed.