Videothoracoscopic wedge resection for peripheral pulmonary nodules

This study was done to evaluate the use of the endoscopic multifire linear stapler for videothoracoscopic wedge resection (VTWR) of peripheral pulmonary nodules and to define the indications, advantages, and drawbacks of this minimally invasive technique.

A case study review of 57 consecutive video-assisted thoracic operations for wedge resection of peripheral pulmonary nodules performed upon 55 patients admitted to a community hospital from June 1991 through July 1993 is presented.

There were 44 malignant and 13 benign lesions. Of the malignant peripheral pulmonary nodules (PPN), there were 19 adenocarcinomas, ten squamous cell carcinomas, two undifferentiated large-cell carcinomas, three bronchoalveolar carcinomas, two carcinoid tumors, one neuroendocrine tumor, and seven metastatic carcinomas. The benign nodules included five hamartomas, two granulomas, one aspergilloma, one nodular amyloidosis, one Wegener's granulomatosis, one focal pulmonary infarct, and two interstitial fibroses. Videothoracoscopic wedge resection alone was performed upon 37 patients, 17 of whom had primary carcinoma of the lung; seven had metastatic lesions, and the remainder had benign disease. Of the 17 patients with primary carcinoma of the lung who had VTWR alone, eight patients had marked impairment of pulmonary function, six had significant co-morbid disease, two had peripheral carcinoid tumors, and one had bilateral metachronous carcinomas. Videothoracoscopic wedge resections with concomitant lobectomies were performed upon 20 patients with primary carcinoma of the lung, including one patient with bilateral synchronous carcinomas. Five of the patients with nodules ranging from 2 to 3 cm in diameter were found to have metastasis to regional nodes. None of the patients who had lobectomies for peripheral carcinomas less than 2 cm in diameter had regional nodal metastases. There was no perioperative mortality and no significant morbidity.

Videothoracoscopic wedge resection is a useful alternative to traditional transthoracic resection for suspicious, undiagnosed PPN, for low grade malignant neoplasms, such as carcinoid, for peripheral metastatic lesions, for bilateral synchronous or metachronous tumors, for the occasional clinically localized peripheral small-cell carcinoma as a surgical adjunct to chemotherapy, and for small, peripheral, T-1, N-0, M-0 bronchial carcinomas in compromised patients at high risk with marginal pulmonary reserve. The procedure is effective, minimally invasive, and has potential advantages over conventional thoracotomy, including less postoperative pain and morbidity, shorter hospitalization period and convalescence, and an earlier return to work and normal activities.