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Robert D. Dowling
Robert J. Keenan
Peter F. Ferson
Rodney J. Landreneau
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Ann Thorac Surg 1993;56:772-775
© 1993 The Society of Thoracic Surgeons

Articles

Video-assisted thoracoscopic resection of pulmonary metastases

Robert D. Dowling, MD, Robert J. Keenan, MD, Peter F. Ferson, MD, Rodney J. Landreneau, MD*

Section of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania USA

* Address reprint requests to Dr Landreneau, Section of Thoracic Surgery, University of Pittsburgh, 5th Floor-East, Montefiore University Hospital 3459 Fifth Ave, Pittsburgh, PA 15213.

Pulmonary lesions in patients with malignancy often require resection to provide prognostic information and to dictate further therapy. Metastasectomy may also favorably influence survival in select patients with favorable tumor histologies. Seventy-two patients with a history of malignancy and new lung lesions identified by high resolution computed tomography underwent thoracoscopic resection. The operative approach was with standard techniques using two or three trocar sites. Preoperative needle localization was used in 13 patients with small lesions that were not immediately subpleural. All target lesions were identified at thoracoscopy. Exploratory thoracoscopy was followed by parenchymal sparing wedge resection with the endoscopic stapler, the neodymium:yttrium-aluminum garnet laser, or both. Histologic analysis revealed metastatic disease in 63 patients and benign disease in 9 patients. The mean diameter of the lesions was 1.6 cm. The mean duration of chest tube drainage and postoperative hospital stay were 2.1 and 4.1 days, respectively. Thoracoscopic resection appears to be a valid approach for diagnostic resection of presumed metastases. The role of thoracoscopy in therapeutic metastasectomy remains to be defined.




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