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Right arrow Lung - cancer

Ann Thorac Surg 2003;75:1607-1611
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Videothoracoscopic management of the solitary pulmonary nodule: a single-institution study on 429 cases

Giuseppe Cardillo, MDa*, Mohamed Regal, MDa, Francesco Sera, Dstatb, Marco Di Martino, MDa, Luigi Carbone, MDa, Francesco Facciolo, MDa, Massimo Martelli, MDa

a Thoracic Surgery Unit, Carlo Forlanini Hospital, Rome, Italy
b The Biostatistics Service, Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, Rome, Italy

Accepted for publication November 13, 2002.

* Address reprint requests to Dr Cardillo, Thoracic Surgery Unit, Carlo Forlanini Hospital, Via Portuense 332, 00149 Rome, Italy
e-mail: gcardillo{at}scamilloforlanini.rm.it

BACKGROUND: Solitary pulmonary nodules (SPNs) sometimes are malignant. We evaluated our 9-year experience in the videothoracoscopic (VATS) management of indeterminate SPNs in order to identify malignant nodules on the basis of clinical and radiologic characteristics.

METHODS: From July 1992 to May 2001, 429 patients (276 men and 153 women) were treated by VATS because of a SPN.

RESULTS: Three hundred and seventy lesions were benign (86.24%): mean age, 49 years; mean diameter, 1.8 cm; evidence of calcifications, 43 cases (11.62%); smokers, 201 cases (54.32%); history of previous cancer, 11 cases (2.97%). Fifty-nine lesions (13.75%) were malignant (52 NSCLC and seven metastases): mean age, 59 years; mean diameter, 2.31 cm; evidence of calcifications, two cases (3.38%); smokers, 40 cases (67.79%); history of previous cancer, 12 cases (20.33%). Solitary pulmonary nodules were succesfully resected by VATS in 333 (77.62%) cases (309 benign and 24 malignant). Minithoracotomy was necessary to locate the SPNs in 93 (21.67%) cases (61 benign and 32 malignant). Multivariate analysis showed that age greater than 55 years (OR 4.9), diameter of the lesion greater than 2 cm (OR 4.7), history of previous cancer (OR 17.7), and need for conversion to thoracotomy (OR 6.6) to locate the nodule were statistically significant factors in order to identify malignant SPNs.

CONCLUSIONS: VATS represents the approach of choice for both diagnosis and treatment of SPNs. The probability of malignancy for SPNs increases with size of the lesion, age of the patients, history of previous cancer, and the need for thoracotomy to locate the nodule.




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