[Videocardioscopy: a new way to assess resectability of cT4 lung cancer by vascular invasion].
OBJECTIVE
To demonstrate the usefulness of intrapericardial inspection of pulmonary vessels by video assisted thoracoscopy (VAT), for determining whether suspicion indicated by computed axial tomography (CAT) or magnetic resonance (MR) scanning is justified or not.


METHODS
Since 1993 we have used exploratory VAT for final staging and assessment of lung cancer resectability. Intrapericardial vascular exploration (IVE) is a complementary method of assessing resectability in cT4 cases. We have performed 20 IVE among 460 VAT when intrapericardial involvement of pulmonary vessels has been suspected (19 men, 1 woman, mean age 64.6 years, range 50-77). VAT demonstrated invasion for 11 patients with previous suspicion based on hilar and vascular invasion shown by CAT scan; in 9 others such involvement was found during IVE for assessing resectability. VAT-IVE was performed through three or sometimes four entrance approaches, from which intrapericardial vessels were explored easily.


RESULTS
Five cases were non-resectable: four due to invasion of the pulmonary artery to its point of origin and one due to extensive invasion of pulmonary veins and the left auricle. The remaining 15 cases were resectable and lesions were removed by posterolateral thoracotomy with intrapericardial dissection and ligature of the vessels. Five had been considered non-resectable by teams at other hospitals where they were classified as advanced cT4 cancers after imaging. The mean duration of IVE was 23 minutes (range 16 to 33); mean postprocedural stay was 48 h in non-resected patients, who were sent for neoadjuvant therapy on the third day. These patients, who underwent only IVE, had no complications and there were no deaths, with five unnecessary thoracotomies avoided.


CONCLUSIONS
IVE allows correct staging of the T parameter in patients for whom T4 classification is suspected, avoiding unnecessary thoracotomies in non-resectable cases and allowing for surgical removal in cases where CAT or MR imaging results are unclear.
Jiménez Merchán
R
R
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla.
Congregado Loscertales
M
M
Girón Arjona
J C
JC
Arenas Linares
J C
JC
Ayarra Jarne
J
J
Loscertales
J
J
D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010496:Pericardium; D019043:Vascular Neoplasms / Q000556:secondary*; D014741:Video Recording