[Pulmonary resection for metastatic gallbladder carcinoma by thoracoscopic surgery--report of a case]

A 58-year-old male was admitted to our hospital 11 months after undergoing a cholecystectomy and partial hepatectomy for carcinoma of the gallbladder with direct invasion of the liver at another hospital. Three round, abnormal shadows had been detected in the lungs by chest roentgenogram, but the patient had neither been diagnosed nor treated. On admission to our hospital, we confirmed three small lesions. Before operative procedure, the lung lesions were diagnosed as adenocarcinoma by transbronchial lung biopsies via fiberoptic bronchoscope and percutaneous needle biopsies. The ipsilateral lung was collapsed during one-lung anesthesia with a Unibent tube, and thoracoscopic surgery was performed using a flexible thoraco-fiberscope and reusable thoracic surgiports of our own design. A wedge resection of the pulmonary lesion was performed by intrathoracic ENDO-DIA. A well differentiated adenocarcinoma defined as a metastasis of gallbladder carcinoma was diagnosed by resected specimen. Thoracoscopic surgery appears to be a safe, effective and less morbid alternative procedure to thoracotomy for carefully selected patients with peripheral pulmonary lesions. Further evaluation and prospective studies are indicated.