Thoracoscopic techniques for the management of intrathoracic metastases. Results

The authors reviewed a series of 74 patients with cancer metastatic to the chest cavity undergoing thoracoscopic procedures. Indications, feasibility, and outcome of thoracoscopy were analyzed.

Perioperative and survival data on patients undergoing 89 operative thoracoscopic procedures between January 1991 and August 1993 were retrieved from a prospective database. These procedures included pulmonary wedge resection (n = 61), lobectomy (n = 2), pleurodesis (n = 11), pleural biopsy (n = 7), decortication (n = 1), and mediastinal mass resection (n = 2). In 13 cases, combined procedures were performed. Five thoracoscopies were converted to open thoracotomies to facilitate resection.

Thoracoscopic pulmonary resections were performed for either diagnostic (n = 45) or curative (n = 18) intent. Diagnostic thoracoscopies were done for lesions in which less invasive biopsy attempts had failed to provide tissue, or that were considered too small for successful percutaneous biopsy. Thoracoscopic diagnostic accuracy was 100%. For the 18 patients undergoing potentially curative resection, mean follow-up is 15.4 months. Sixteen of these patients are currently alive, and eight are free of disease. Five complications related to the procedure included persistent air leak (n = 2), atrial fibrillation (n = 2), and urinary retention (n = 1). Overall hospital stay for thoracoscopic lung resection was 4.6 +/- 2.2 days, for converted open thoracotomy 6.8 +/- 1.9 days, and for patients undergoing pleurodesis 8.9 +/- 5.3 days. Mean chest tube duration after thoracoscopic resection was 2.6 +/- 1.6 days.

Thoracoscopic procedures are safe, well tolerated, and useful for diagnosis and treatment of selected patients with suitable intrathoracic metastatic disease.