title: A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches.
abstract: OBJECTIVE
  The aim of the present paper was to conduct a comparative analysis of outcomes after thoracoscopic resection versus standard thoracotomy approach in the treatment of Pancoast tumours.
  
  
  METHODS
  All consecutive patients with Pancoast tumours undergoing surgical treatment from March 2000 to November 2012 were enrolled. Patients were divided into 2 groups according to whether a thoracoscopic or standard thoracotomy approach was adopted. In addition to morbidity and mortality, (i) intensity of pain; (ii) respiratory function focusing on the postoperative value and its variation with respect to the predicted value (Delta); (iii) analgesic consumption at different times during the postoperative course; and (iiii) survival rate were recorded in both groups and the inter-group differences were statistically compared.
  
  
  RESULTS
  Of the 45 enrolled patients, 34 (75%) were included in the final analysis (18 in the thoracoscopic group and 16 in the standard group). Eleven (25%) patients were excluded because they (i) were unfit for surgery after induction therapy (n = 4); (ii) refused the operation (n = 1) or (iii) had unexpected pleural involvement (n = 6). Compared with the standard group, in the thoracoscopic group we observed less pain (P = 0.01), better recovery of forced vital capacity (P = 0.01) and forced expiratory value in 1 s (P < 0.001), and a reduction in opioid (P = 0.01) and analgesic consumption (P = 0.02). The median survival for all patients was 15 months. Patients with N0/N1 disease had better median survival than N2 patients (47 vs 9 months; P = 0.009). One local recurrence in the standard group was observed 1 year after operation, whereas 2 local recurrences, 1 in the thoracoscopic group and another in the standard group, were registered 2 years after the operation (P = 1.0). Finally, 4 (22%) extrathoracic metastases in the thoracoscopic group and 5 (31%) in the standard group (P = 0.8) were found over the 2 years following the procedure.
  
  
  CONCLUSIONS
  In the management of Pancoast tumours, a thoracoscopic approach is safe and may be an effective adjunct to standard surgical resection in selected cases. Such an approach enabled surgeons to explore the pleural cavity and avoid exploratory thoracotomy in cases of unexpected pleural involvement.
authors: Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy fpcaronia@yahoo.it.
authors: Francesco Paolo
authors: FP
authors: Caronia
authors: Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy.
authors: Alfonso
authors: A
authors: Fiorelli
authors: Unità Operativa di Chirurgia Toracica, Università di Torino, Torino, Italy.
authors: Enrico
authors: E
authors: Ruffini
authors: Chirurgia Toracica, Ospedale Cannizzaro, Catania, Italy.
authors: Maurizio
authors: M
authors: Nicolosi
authors: Unità Operativa di Chirurgia Toracica, Seconda Università di Napoli, Napoli, Italy.
authors: Mario
authors: M
authors: Santini
authors: Dipartimento di Chirurgia 'GENURTO', Università di Palermo, Palermo, Italy.
authors: Attilio Ignazio
authors: AI
authors: Lo Monte
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010178:Pancoast Syndrome / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Pancoast tumour; Superior sulcus tumour; Surgery; Thoracotomy; Video-assisted thoracoscopic resection