Major pulmonary resection for suspected but unconfirmed malignancy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Thoracotomy is often performed for suspected pulmonary carcinoma without definitive pre-operative diagnosis.
• Intraoperative decisions for major pulmonary resection (lobectomy or pneumonectomy) are challenging with large or central lesions.
• Biopsy methods like incisional or needle biopsies can be inconclusive and compromise cancer surgery principles.

Purpose of the Study:

• To evaluate the safety and outcomes of major pulmonary resection in patients with suspected but unconfirmed lung malignancy.
• To determine if lobectomy can be safely performed without a definitive pre-operative cancer diagnosis.
• To compare operative mortality between lobectomy and lesser resections in this patient cohort.

Main Methods:

• Retrospective review of 303 patients undergoing thoracotomy for suspected malignancy between 1970 and 1980.
• Analysis of outcomes for patients undergoing minor resection, major resection with frozen section diagnosis, and major resection without definitive diagnosis.
• Comparison of operative mortality and final diagnoses in different surgical groups.

Main Results:

• Of 102 patients undergoing major resection without definitive diagnosis, 68% had carcinoma and 32% had benign lesions.
• Operative mortality was similar between lobectomy (2%) and lesser resections (1.6%) across all 303 patients (p<0.01).
• Two 30-day operative deaths occurred in the 69 patients with malignancy in the 'no definitive diagnosis' group.

Conclusions:

• Lobectomy is a safe procedure for suspicious but inaccessible pulmonary lesions when definitive diagnosis is lacking pre-operatively.
• Performing lobectomy in such cases adheres to principles of cancer surgery.
• Pneumonectomy is not recommended without a confirmed diagnosis due to higher associated morbidity and mortality.