Exploratory thoracotomy in bronchial carcinoma

Of 2,540 patients with bronchial carcinoma, 1,223 (48.1%) were judged primarily to have inoperable disease. Of the 1,317 (51.9%) patients who seemed operable, 150 (11.4%) proved to have inoperable lesions at thoracotomy. The resectability rate was 45.9%. The difference between the clinical and surgical staging, i.e., the ultimate reason for inoperability, had various causes: inadequate assessment of the available radiologic data, inadequate performance of mediastinoscopy, and pleural or thoracic wall involvement without clinical suspicion preoperatively. Exploratory thoracotomy cannot always be avoided. However, it seems important that physicians check their results with exploratory thoracotomy to improve the quality of the diagnostic procedures in the preoperative work-up.