Ann Thorac Surg 1995;59:870-871
© 1995 The Society of Thoracic Surgeons
Invited Commentary
INVITED COMMENTARY
Franz Eckersberger, MD
Department of Cardiothoracic Surgery University Hospital of Vienna Währinger Gürtel 18-20 A - 1090 Vienna, Austria
See also page 868.
It is a pleasure to congratulate Dr Sambrogio and associates on this very important investigation with clear results and statements referring to a common problem in lung surgery. We have to realize that exact signs of benignancy of SPNs do not exist including calcium in nodules or even observation during years. We have to emphasize that 60% of SPNs are malignant depending on age, sex, smoking, and history of chronic inflammatory disease. Aditionally, in patients with history of other malignant tumors in different organs we have to consider that up to 20% are second primary lung tumors and that CT-guided needle biopsy allows at the most diagnosis of a benign or malignant tumor, but further differenciation between primary tumor or metastasis, especially in adenocarcinomas and squamous cell carcinomas, is mostly impossible.
Surveying different authors, conversion rates up to 30% are listed but seem to depend on the training status as well as on the selection of the patients. Before the decision for open thoracotomy is made for exstirpation of an SPN, VATS should be applied in any case for a well-defined time. Even in cases of access thoracotomy without using a rib retractor the benefits of VATS for the patient are obvious regarding the period of hospitalization and the postoperative pain. In our institute we had similar results analyzing about 200 cases. However, no difference could be noticed concerning the drainage duration in comparison with patients treated by open thoracotomy.
In conclusion, it is no longer justified to observe an SPN even for a definite period of time, excluding patients with a high risk for general anesthesia or patients in whom further surgical treatment would be required from the oncologic point of view but cannot be carried out due to excessively poor lung function.
The (higher) costs of this technique should be calculated and argued in consideration of the savings due to the shorter hospitalization period. Additionally, decreased costs of instruments can be expected for the future.
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Videothoracoscopy Versus Thoracotomy for the Diagnosis of the Indeterminate Solitary Pulmonary Nodule
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Ann. Thorac. Surg. 59: 868-870.
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