title: Routine use of staging thoracoscopy for pancoast tumors without overt radiographic chest wall invasion.
abstract: A retrospective review was performed of all patients with upper lobe non-small cell lung cancers to assess the use of thoracoscopy in determining chest wall invasion in patients with lung cancers abutting the first rib, but without overt radiographic invasion. Of the 12 patients with tumors abutting the first rib without overt radiographic invasion, thoracoscopy was able to correctly determine chest wall invasion in 8 patients. There was no significant morbidity related to thoracoscopy. Large tumor size did not preclude thoracoscopic staging, whereas dense adhesions did limit the use of staging thoracoscopy. Patients with invasion by thoracoscopy were able to begin radiation or chemotherapy much sooner (median 22.3 d) than patients requiring thoracotomy (median 60 d). The routine use of staging thoracoscopy in all tumors abutting the first rib without overt radiographic evidence of invasion accurately identified apical chest wall involvement in 8 of 12 patients. With this strategy, unnecessary neoadjuvant treatment and futile thoracotomy may be avoided.
authors.affiliation: Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Hubbard
authors.forename: Carsten
authors.initials: C
authors.lastname: Schroeder
authors.forename: Philip A
authors.initials: PA
authors.lastname: Linden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010178:Pancoast Syndrome / Q000473:pathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000209:etiology / Q000473:pathology; D035441:Thoracic Wall / Q000000981:diagnostic imaging / Q000473:pathology*; D013906:Thoracoscopy / Q000295:instrumentation / Q000379:methods*; D013908:Thoracotomy / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome