Video-assisted thoracic surgery. Staging and management of thoracic tumors.

BACKGROUND

This prospective study was conducted to investigate the value of video-assisted thoracic surgery (VATS) for staging and therapy of thoracic tumors.

METHODS

VATS was performed in 86 patients presenting peripheral pulmonary nodules. Indications for thoracoscopy included diagnosis of indeterminated pulmonary lesions (n = 55), staging of disseminated disease (n = 24), and therapeutic interventions (n = 7). Previous or simultaneous tumors belonged to gastrointestinal tract (n = 27), sarcoma (n = 19), breast (n = 12), and miscellaneous. VATS was carried out under general anesthesia using double lumen intubation.

RESULTS

VATS was successfully performed in 78% of patients. It was converted in 19 patients (22%) because of adhesions (n = 12), technical problems (n = 3), and lesions not to be found (n = 4). VATS revealed malignancy in 81% and benign lesions in 19%. Additional information compared to conventional staging was obtained in 48%, resulting in therapeutic consequences in 34% of the patients. Postoperative complications related to VATS were observed in nine patients.

CONCLUSIONS

In this study, VATS proved to be a sensitive technique for staging of pulmonary lesions. Thoracoscopic wedge resection may have significant impact on the operative management of carefully selected patients with peripheral pulmonary lesions.