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Ann Thorac Surg 2003;76:342
© 2003 The Society of Thoracic Surgeons

Correspondence

Reply

Jesús Loscertales, MD, PhD

Hospital Universitario Virgen Macarena,Auda Dr. Fedriani 1,41071 Seville, Spain,

e-mail: jlocert{at}us.es

To the Editor:

I am writing in regard to the letter by Dr Wurtz. In the opinion of my co-workers and myself, the subxiphoid approach is not a suitable pathway through which to explore pulmonary vessels in patients with clinical T4 lung cancer because the location of the heart impairs proper visualization of the pulmonary vessels.

In our series of 27 patients with pericardial tumor extension who underwent videopericardioscopy (VPC) [1], computed tomography (CT) and magnetic resonance imaging (MRI) did not reveal such accurate images as they did in the experience of Dr Wurtz. In 15 of our patients, vascular invasion was suggested by CT or MRI, but 14 had resectable tumors as established by VPC. In the other 12 patients, vascular invasion was not suspected after CT or MRI. These patients underwent exploratory video thoracoscopy, which demonstrated unsuspected tumors. At VPC, 5 of the patients were found to have inoperable disease because of intrapericardial vascular invasion.

We think that VPC performed under the same conditions as exploratory videothoracoscopy (the first step in the surgical evaluation of lung cancer) allows adequate visualization and assessment of pulmonary vessels to determine resectability. Videopericardioscopy also avoids open-field sharp dissection.

Lateral positioning of the patient permits complete visualization of the ipsilateral pulmonary vessels. We do not believe this is possible using the subxiphoid incision.

On the basis of our experience, my colleagues and I conclude that VPC can add important information to that obtained from CT and MRI.

References

  1. Loscertales J., Jiménez-Merchán R., Congregado-Loscertales M., et al. Usefulness of videothoracoscopic intrapericardial examination of pulmonary vessels to identify resectable clinical T4 lung cancer. Ann Thorac Surg 2002;73:1563-1566.[Abstract/Free Full Text]




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