Diagnostic and therapeutic video-assisted thoracic surgery resection of pulmonary metastases.
BACKGROUND
Appropriateness of video-assisted thoracic surgery (VATS) pulmonary metastasectomy for curative intent has been a controversial topic. We reviewed our experience with VATS wedge resection for peripheral lung metastases to determine the efficacy and potential adverse consequences of this approach for pulmonary metastasectomy.


METHODS
One hundred seventy-seven patients underwent VATS resection of pulmonary metastases. Diagnostic resection (VATS-dx) was performed for 78 patients when percutaneous biopsy was unsuccessful or not feasible. Potentially curative resections (VATS-rx) were performed for 99 patients. The histologic findings in this group included colorectal (68), renal (7), sarcoma (6), breast (4), melanoma (3), head/neck (3), lymphoma (2), uterine (1), and "other" (5). The average number of lesions resected was 1.4 (range, 1-7).


RESULTS
VATS resection was successfully performed for all VATS-dx and VATS-rx patients. There were no perioperative deaths. Longitudinal follow-up demonstrated a mean survival of 18 months in the VATS-dx group and 28 months in the VATS-rx group. In the VATS-rx group, 37 (37%) of 99 were free of disease, at a mean follow-up interval of 37 months. Of the 57 recurrences, 5% were local, 26% were regional, and 69% were distant.


CONCLUSIONS
Results with VATS resection of peripheral pulmonary metastases for diagnostic and potentially curative intentions appear comparable with historical results by "open" thoracotomy. Careful patient selection based on high-resolution helical CT scanning is important to avoid compromise of therapeutic intent. Conversion to thoracotomy is indicated when lesions identified preoperatively are not found or when technical problems encountered may compromise surgical margins when resecting lung metastases for potential cure.
Lin
J C
JC
Allegheny University Hospitals, Allegheny General, Pittsburgh, PA 15212, USA.
Wiechmann
R J
RJ
Szwerc
M F
MF
Hazelrigg
S R
SR
Ferson
P F
PF
Naunheim
K S
KS
Keenan
R J
RJ
Yim
A P
AP
Rendina
E
E
DeGiacomo
T
T
Coloni
G F
GF
Venuta
F
F
Macherey
R S
RS
Bartley
S
S
Landreneau
R J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery*; D008223:Lymphoma; D008297:Male; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000517:prevention & control; D009366:Neoplasm Seeding; D012509:Sarcoma / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery*; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology; D014741:Video Recording