title: [Exploratory videothoracoscopy and videopericardioscopy in the definitive staging and assessment of resectability of lung cancer].
abstract: OBJECTIVE
  We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer.
  
  
  METHODS
  Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancer staging and assessment of resectability. When intrapericardial vessel involvement is suspected, exploration by videopericardioscopy (VPC) is also useful for assessing resectability in these cT4 cases. Up to December 2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In the remaining 46, it was performed as a result of EVT findings.
  
  
  RESULTS
  We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients; thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases (10.2%) tumors were considered unresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinomatosis in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in 16 patients who were unable to tolerate pneumonectomy. In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17 cases), of the upper pulmonary artery and vein (6 cases), of the upper pulmonary artery and superior vena cava (2 cases), or of the left atrium and pulmonary veins (5 cases, in which the invasion was extensive).
  
  
  CONCLUSIONS
  EVT and VPC as a first step in lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies.
authors.affiliation: Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España. rmerchan@us.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Jiménez Merchán
authors.forename: Miguel
authors.initials: M
authors.lastname: Congregado Loscertales
authors.forename: Gregorio
authors.initials: G
authors.lastname: Gallardo Valera
authors.forename: Ana
authors.initials: A
authors.lastname: Triviño Ramírez
authors.forename: Javier
authors.initials: J
authors.lastname: Ayarra Jarne
authors.forename: Jesús
authors.initials: J
authors.lastname: Loscertales
mesh_terms: D002283:Carcinoma, Bronchogenic / Q000473:pathology / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D010496:Pericardium / Q000473:pathology*; D010997:Pleural Neoplasms / Q000556:secondary; D011013:Pneumonectomy / Q000379:methods; D011651:Pulmonary Artery / Q000473:pathology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*