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Ann Thorac Surg 2000;69:1581
© 2000 The Society of Thoracic Surgeons

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Invited commentary

Invited commentary

^a Section of Thoracic Surgery, Evanston Northwestem Healthcare, 2500 Ridge Ave, Evanston, IL 60201, USA

This article again emphasizes the problems of tumor implantation that can occur after thoracoscopic resection of malignancies. It is understood that many cancers have been resected by VATS without chest wall complication. On the other hand, the list of tumor implants following a VATS resection continues to grow. After our report 5 years ago of a malignant implant following a VATS resection with fatal outcome [1], we instituted a program that we hoped would decrease the chance of implantation:

1. Avoid VATS for resection of a known primary lung cancer.
   
2. If VATS is used for exploration of an indeterminate lung lesion that turns out to be malignant, convert to an open procedure as soon as the diagnosis of malignancy is confirmed. Often an intraoperative fine-needle aspiration biopsy with immediate reading can be helpful in making an early operative diagnosis of malignancy.
   
3. Remove all VATS wedge resection specimens in a receptacle if there is any chance of the lesion being malignant.
   
4. Make sure that all surgical margins are tumor free.
   
5. Following a VATS resection that involves malignancy, perform a thorough lavage of the entire surgical field, including port sites, with sterile water, whether or not the case was converted to an open thoracotomy.
   

Despite using this strategy, we have recently experienced yet another case of tumor implantation following VATS resection of a metastatic rectal cancer from the lung, as shown in this CT scan (Fig 1) taken 19 months after the initial VATS resection. The chest wall nodule (arrow) was palpable and was positive for adenocarcinoma on fine-needle aspiration.

View larger version (117K): [in this window] [in a new window]   Fig 1. Computed tomography scan showing a malignant chest wall implant (arrow), which was diagnosed 19 months after a VATS resection of a malignancy.

References

1. Fry W.A., Siddiqui A., Pensler J.M., Mostafavi H. Thoracosopic implantation of cancer with a fatal outcome. Ann Thorac Surg 1995;59:42-45.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Willard A. Fry Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Fry, W. A. Search for Related Content PubMed PubMed Citation Articles by Fry, W. A. Related Collections Related Article