Is there a role for video-assisted thoracoscopy in the staging of non-small cell lung cancer?
OBJECTIVE
To evaluate the role of video-assisted thoracoscopy (VAT) in the staging of non-small cell lung cancer (NSCLC).


METHODS
In 30 patients (18 male, 12 female, median age 62 (50-78) years) VAT was used to assess the operability of NSCLC in cases where doubt existed after conventional staging investigations had been performed.


RESULTS
VAT was used to assess direct tumour invasion of adjacent organs in 17 patients (mediastinal invasion in 14 and chest wall invasion in 3 patients). In 4 patients with limited respiratory reserve, VAT confirmed the need only for lobectomy prior to thoracotomy. Mediastinal lymph node biopsy was performed in 5 patients with significant (> 1.5 cm) lymphadenopathy on CT scan. VAT was also used to assess bilateral lesions in 4 patients with suspected synchronous tumours. Conversion to thoracotomy was necessary in 4 patients for technical reasons. Successful resection was possible in 17 of the remaining 26 cases, while unnecessary thoracotomy was avoided in 9 patients (30%) with unresectable or benign disease. In 4 patients deemed inoperable on CT scan, VAT staging enabled subsequent resection.


CONCLUSIONS
Video-assisted thoracoscopy appears to have a complementary role in staging NSCLC when other methods are equivocal. It has the potential for increased sensitivity over conventional staging methods.
Waller
D
D
Department of Thoracic Surgery, Heartlands Hospital, Birmingham, UK.
Clarke
S
S
Tsang
G
G
Rajesh
P
P
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D012680:Sensitivity and Specificity; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000379:methods; D014741:Video Recording