title: Transxiphoid video-assisted pulmonary metastasectomy: relevance of helical computed tomography occult lesions.
abstract: BACKGROUND
  The new transxiphoid video-assisted approach allows manual palpation of both lungs, thus permitting better evaluation of helical computed tomography (CT) in detection of pulmonary metastases.
  
  
  METHODS
  From December 1995 to May 1999, 22 patients underwent a transxiphoid video-assisted pulmonary metastasectomy. Manual palpation of both lungs was possible in 18 patients, whereas only 13 had radiologic evidence of unilateral disease. Primaries were colon-rectum (n = 8), kidney (n = 3), uterus (n = 2), larynx (n = 2), limb osteosarcoma (n = 2), and one each of breast, skin melanoma, prostate, fibrosarcoma, and ovary.
  
  
  RESULTS
  No perioperative death occurred. Fifty-eight lesions, 49 metastatic, were resected, whereas only 46 had been predicted by helical CT scan. Twelve occult lesions were discovered, eight of which were malignant. Overall sensitivity for proved metastases was 83.7% (41 of 49) and 75.8% (22 of 29) for those less than or equal to 5 mm. Mean follow-up was 15.27 months. Only 2 patients had pulmonary relapse at 6 and 12 months.
  
  
  CONCLUSIONS
  Despite helical CT, occult metastases may still be identified in almost one-third of the patients. The transxiphoid approach allows routine bilateral palpation and safe resection, and overcomes this critical limitation of video-assisted metastasectomy.
authors.affiliation: Department of Thoracic Surgery, Tor Vergata University, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ambrogi
authors.forename: M
authors.initials: M
authors.lastname: Paci
authors.forename: E
authors.initials: E
authors.lastname: Pompeo
authors.forename: T C
authors.initials: TC
authors.lastname: Mineo
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D012086:Reoperation; D020775:Thoracic Surgery, Video-Assisted; D014057:Tomography, X-Ray Computed