title: Video-assisted versus open pulmonary metastasectomy: the surgeon's finger or the radiologist's eye?
abstract: OBJECTIVE
  The use of VATS metastasectomy remains controversial because of doubt surrounding its ability to remove palpable but CT occult lesions. We aim to evaluate our policy of elective VATS and compare it with our results with open metastasectomy.
  
  
  METHODS
  Pulmonary metastasectomy was performed for metastatic colorectal adenocarcinoma in 52 patients: 27 open and 25 VATS over 8 years. The age and sex distribution was similar: median age was 66 for open and 69 years for VATS, p=0.48, 70% male in open and 64% male in VATS, p=0.31. Liver metastases were present in 37% in the open and 32% in the VATS group, p=0.46. The choice of surgical approach was dependent on the distance of the lesion from the surface of the lung. We examined the survival using the Kaplan-Meier method and we tested for differences in the incidence of missed lesions, pulmonary disease progression and repeat metastasectomy.
  
  
  RESULTS
  There was no in-hospital mortality. There was no difference in the incidence of missed lesions (1 in VATS, none in open, p=0.48), pulmonary disease progression (11 in open, 9 in VATS, p=0.47) or recurrence in the same lobe (4 in open, 3 in VATS, p=0.54). Median follow-up was 22 (1-70) months and there was no difference to the estimated actuarial survival. Mean survival for the open group was 47 months, SE 6 with 95% CI 36-59 months and mean survival for the VATS group 35.4 months, SE 3 with 95% CI 30-41.3 months. The estimated 1- and 2-year survival was 90% and 80% for open and 90% and 72% for VATS.
  
  
  CONCLUSIONS
  The selective use of VATS therapeutic metastasectomy in conjunction with multi-detector CT is justified in metastatic colorectal adenocarcinoma. The insertion of the surgical digit is not mandatory. Trust the radiologist's eye.
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Nakas
authors.forename: Michael N
authors.initials: MN
authors.lastname: Klimatsidas
authors.forename: James
authors.initials: J
authors.lastname: Entwisle
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.forename: David A
authors.initials: DA
authors.lastname: Waller
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome