[A therapeutic metastasectomy of pulmonary metastases by VATS]

The use of VATS to perform diagnostic metastasectomy is uniformly accepted, but the role of therapeutic VATS metastasectomy remains controversial. We retrospectively compared the value of therapeutic metastasectomy by VATS with that by open thoracotomy in the management of pulmonary metastatic tumors. The forty-six patients who underwent a complete metastasectomy of pulmonary metastatic tumors were divided into groups: one group in which metastasectomy was performed by VATS (VATS group; 23 cases, 25 operations) and another group in which metastasectomy was performed by open thoracotomy (Thoracotomy group 23 cases, 26 operations). Here, complete metastasectomy means compete resection of all tumors, which were detected by preoperative high resolution computed tomography in both groups and also by intraoperative manipulation in the thoracotomy group, without positive lesions of the surgical margin. The groups were matched with respect to preoperative clinical characteristics (age, sex, primary lesion, disease-free interval) and histological findings (maximum tumor size, number of metastatic tumors, minimum distance between surgical margin and tumor edge). The cumulative survival one-year and three-year rates were 83.5 and 83.5% in the VATS group, and 89.5 and 77.5% in the thoracotomy group, respectively. The cumulative one-year and three-year non-recurrence rates were 72.3 and 68.0% in the VATS group and 83.9 and 63.8% in the thoracotomy group, respectively. There were no significant differences between the two groups. We conclude that pulmonary metastasectomy by VATS can be used safely not only as a diagnostic but also therapeutic tool if complete resection is done following diagnosis by preoperative high resolution computed tomography.