Thoracoscopic chest wall resection: what is its role?
BACKGROUND
Although thoracoscopic operations like pulmonary lobectomy are gaining popularity because of reduced complications and improved quality of life, the role of more complex procedures is unknown.


METHODS
From January 2007 to April 2009, 3 patients (2 women) aged 61, 71, and 79 years, underwent thoracoscopic lobectomy with en bloc chest wall resection in an attempt to reduce perioperative morbidity. During the same time, 4 additional patients underwent thoracoscopic explorations before open en bloc resections and 10 underwent thoracotomy to remove primary or secondary chest wall neoplasms. Innovations that facilitated the thoracoscopic operations were the use of an endoscopic rib cutter and division of other chest wall tissues with thermal sealing technology.


RESULTS
Tumors were stage IIb-IIIa and sized 3.2 to 5 cm. Two patients received neoadjuvant therapy before resection. No patients required reconstruction. The first patient required thoracoscopic reexploration to evacuate a hematoma attributed to aggressive anticoagulation required because of high-risk cardiac comorbidities. No other complications occurred. By 3 weeks after resection, the first patient had discontinued narcotics, and the other patients denied pain and analgesic use entirely. All patients were alive, with no evidence of disease, at 26, 16, and 6 months after their operations.


CONCLUSIONS
Highly selected cases of lung cancer with chest wall extension are appropriate candidates for thoracoscopic resection. Advanced thoracoscopic instrumentation makes this procedure feasible while following oncologic principles.
Demmy
Todd L
TL
Department of Thoracic Surgery, Roswell Park Cancer Institute and University at Buffalo, Buffalo, New York 14263, USA. todd.demmy@roswellpark.org
Nwogu
Chukwumere E
CE
Yendamuri
Sai
S
D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000601:surgery*; D013906:Thoracoscopy