[VATS (video-assisted thoracoscopic surgery): possibilities and limits of surgical therapy of malignant lung diseases].

VATS is able to perform by minimal access all operations known in general thoracic surgery. Mortality (0.07-1.9%) is low and complications (4.3-14.2%) are rare, as published in four studies in the last two years. Especially long-term results of VATS in malignant disease are not clear. Indications and limitations for VATS in bronchial carcinoma and lung metastases are discussed. Surgical treatment in peripheral non-small cell lung cancer has best results after lobectomy. Limited resection decreases the oncological result (5-year-survival-rate) by 10 to 18% compared to lobectomy. Conservative treatment with radiotherapy in stage I carcinomas in patients who are not eligible for open lobectomy because of restricted lung function or other non oncological reasons has a bad prognosis (0-12% 5-y-survival). In these cases VATS resection of bronchial carcinoma should by considered. Detection of all lung metastases by preoperative radiological study is only in 56-75% possible. Between 10/93-2/98 we performed 52 thoracotomies for lung metastases at our surgical department. In eight cases bronchial carcinoma was confirmed by histological examination, nine patients with metastases of malignant germ-cell-tumors were excluded from the study. CT-scan of the lung was performed preoperatively. In 43% of the cases (n = 35) additional lesions were detected intraoperatively by palpation of the lungs. Histopathologic examination revealed benign lesions in 9% and malignant in 34%. The result of lung metastases resection is highly dependent on the completness of extirpation. We therefore conclude that lung metastases should be removed by open thoracotomy.