Staged axillary thoracotomy for bilateral lung metastases: an effective and minimally invasive approach.
OBJECTIVE
We describe our experience with the staged axillary thoracotomy (SAT), for the treatment of bilateral lung metastases.


METHODS
Between January 1995 and June 1998, 75 lung metastasectomies were carried out in our institution, 49 (65%) monolateral, and 26 (35%) bilateral. In the latter group of patients we adopted a staged axillary thoracotomy.


RESULTS
All wedge resections and two lobectomies (1 LUL and 1 RLL) were performed through this approach. Resection has been complete in all patients. Histology was epithelial in 15 (57%), sarcoma in nine (35%) and germ cell in two (8%). Two to three metastases have been resected in 10 patients (38%); four to 10 in 12 patients (46%) and over 10 in four patients (15%). The radiological pre-operative assessment was accurate in 15 patients (57%), underestimated in nine (35%) and overestimated in two (8%). The average interval between the two procedures has been 24 +/- 6 days. The average operation duration time was 50 min (range 36-67). We do not report any post-operative death or major complication. The average hospitalization was 3.2 days (range 2-6) for each single procedure and 6.2 days (range 4-10) for both procedures.


CONCLUSIONS
This technique is adequate, fast and safe and did not affect the shoulder girdle motion at all providing an excellent cosmetic outcome. The operative trauma is limited and a minor post-operative pain is present. A shortening of the interval between the two operations is allowed.
Margaritora
S
S
General Thoracic Surgery, Catholic University of Rome (Divisione di Chirurgia Toracica, Università Cattolica del Sacro Cuore), Italy. stemargaritora@yahoo.com
Cesario
A
A
Galetta
D
D
Kawamukai
K
K
Meacci
E
E
Granone
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001365:Axilla / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000556:secondary; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000473:pathology / Q000556:secondary; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods; D011013:Pneumonectomy / Q000379:methods*; D012509:Sarcoma / Q000473:pathology / Q000556:secondary; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome