[Exploratory thoracotomy of necessity in surgery of bronchial cancer]

The survey conducted by the French Language Society of Thoracic and Cardiovascular Surgery collected a total of 2,962 exploratory thoracotomies for lung cancer performed over a period of 10 years. Over the same period, 25,291 operations were performed for lung resection, so that the mean rate of exploratory thoracotomy was therefore 11.7%. The rate of exploratory thoracotomy varied from one unit to another (2.7% to 45.8%) and appeared to be virtually independent of the operative activity. It has continued to decrease over time, which is even more significant in view of the fact that the operative activity has increased in all of the units. The local and regional spread of the tumour represents the principal reason for non-resection (79% of cases); it was less common in units with a high operative activity (72%) than in other units (84%) especially when the mediastinal lymph nodes were involved. The major thoracic surgery units also appear to be distinguished by a greater audacity, as well as an increased failure rate in the case of tumour spread to the trachea. The risk of exploratory thoracotomy is considerable as it was responsible for death in 3% of cases. A better radiological and clinical assessment, rather than the use of mediastinoscopy should avoid 2% of these useless explorations. The subsequent course of these patients barely concerns the surgeon: it is rapidly unfavourable and the rare long-term survivals (2% at five years) are not sufficient to justify operation at any cost.