Video-assisted thoracoscopy and the staging of lung cancer

Video-assisted thoracoscopy (VAT) provides an opportunity for evaluation and biopsy within the pleural space and at the pulmonary hilum. The application of a standardized approach for VAT in patients with primary lung cancers was evaluated. Of 49 patients, 6 patients could not be evaluated due to intrapleural adhesions. Of the remaining 43 patients, an unsuspected parietal pleural metastasis was identified in 2, obviating further surgery. The other 41 patients underwent anatomic resection after VAT staging, which was carried out during the same operative procedure. Pathologic staging of the specimens revealed 20 T1 N0, 10 T2 N0, 5 T1 N1, and 6 T2 N1 lesions. Among the T2 lesions, 10 of 16 (63%) involved visceral pleural invasion, all of which were identified at VAT staging. Among the N1 lesions, 6 of 11 (55%) were identified at VAT staging; in the remainder, N1 nodes were not accessible to biopsy. No morbidity or mortality was noted. Routine VAT staging in patients with lung cancer is a safe technique, reduces the need for an exploratory thoracotomy, and may identify patients with localized lung cancers who are at high risk for postoperative recurrence.