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Thoracoscopic or open surgery for pulmonary metastasectomy: an observer blinded study
1Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
The Annals of Thoracic Surgery
|June 15, 2014
Summary
Video-assisted thoracic surgery (VATS) may miss malignant pulmonary nodules. Thoracotomy revealed unexpected lesions, suggesting VATS alone is insufficient for complete lung metastasis resection.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Video-assisted thoracic surgery (VATS) for pulmonary metastases is debated due to potential missed lesions.
- Advancements in VATS technology have led to its routine global use.
Purpose of the Study:
- To prospectively evaluate the efficacy of VATS in detecting and resecting all pulmonary metastases.
- To compare nodule detection rates between VATS and open thoracotomy.
Main Methods:
- Prospective, observer-blinded study comparing high-definition VATS with digital palpation to immediate thoracotomy with bimanual palpation.
- Patients with oligometastatic pulmonary disease on CT scans were included.
- Two surgical teams performed VATS and thoracotomy sequentially under the same anesthesia.
Main Results:
- Of 140 nodules visible on CT, VATS palpated 122 (87%).
- Thoracotomy identified 67 additional nodules missed by VATS.
- These missed nodules included 22 metastases, 43 benign lesions, and 2 primary lung cancers.
Conclusions:
- A significant number of malignant and benign pulmonary nodules are missed with VATS alone.
- Thoracotomy remains crucial for complete resection of pulmonary metastases.
- Current VATS technology is inadequate for ensuring complete resection of all pulmonary nodules.
