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Clinical pathway for impalpable or small lung lesions treated with coil marking and thoracoscopy
J Yoshida1, T Shirota, A Tanimura
1Department of Chest Surgery, Shimonoseki City Hospital, 1-13-1 Koyo-cho, Shimonoseki 750-8520, Japan. info@yoshidaj.com
Objectives:
Advances in computed tomography are detecting increasingly impalpable or small pulmonary lesions. We propose a clinical pathway for managing such lesions.
Methods:
We conducted a retrospective study in a community teaching hospital to describe the hospital schedules of 18 patients having 19 lesions 10 mm or less and ground glass attenuation. Under computed tomography, a coil (Complex Helical Fibered Platinum Coil-18) was placed at the proximal side of the lesion. Using thoracoscopy and radiographic fluorography, we conducted partial lung resection targeting the coil the next day, adding lobectomy, if required.
Results:
Final diagnosis included primary and metastatic lung cancer (n = 14), atypical adenomatous hyperplasia (n = 1), and benignancy (n = 4). Patients were admitted 2* days before surgery (*Numbers are medians). On postoperative day 3, chest tubes were removed. Epidural analgesia was continued for 5 days. On postoperative day 7, patients were discharged. Their admission charge was a total of yen 979,610.
Conclusions:
The hospital course above may be applied to the clinical pathway for managing impalpable or small lung lesions.