Hand-assisted thoracoscopic surgery for pulmonary metastasectomy through sternocostal triangle access: superiority in detection of non-imaged pulmonary nodules.

Hand-Assisted Thoracoscopic Surgery for pulmonary metastasectomy through sternocostal triangle access allows manual palpation of both lungs, thus permitting effective treatment of lung metastases. In our research, 62 patients from November 2001 to January 2012 underwent our Hand-Assisted Thoracoscopic Surgery procedures for pulmonary metastasectomy. Clinical data, including the number of pulmonary metastases determined by Computed Tomography/Positron Emission Tomography-Computed Tomography, surgical findings and survival data of these patients were collected. We found that the median follow-up time was 23.7 months (range 2.4 to 85.6 months). 30 cases of them had post-operative recurrences and the median disease-free survival period was 27.4 months. For Computed Tomography scan, the overall sensitivity for proved metastases was 63% (115/182). 67 non-imaged malignant nodules were palpated and removed in 14 cases. For Positron Emission Tomography-Computed Tomography scan, the overall sensitivity was 66% (79/120). 41 non-imaged malignant nodules were palpated and removed in 12 cases. This study show that the Hand-Assisted Thoracoscopic Surgery provides an easier way for routine bilateral pleural exploration, and thus is critical and effective in detection of non-imaged malignant pulmonary metastases, which might contribute to long-term disease-free survival.