Exploratory videothoracoscopy and videopericardioscopy in the definitive staging and assessment of resectability of lung cancer

• Published in: Archivos de bronconeumología (English ed.) Vol. 45; no. 9; pp. 435 - 441
• Main Authors: Jiménez Merchán, Rafael, Congregado Loscertales, Miguel, Gallardo Valera, Gregorio, Triviño Ramírez, Ana, Ayarra Jarne, Javier, Loscertales, Jesús
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.09.2009
• Subjects: Carcinoma, Bronchogenic - pathology; Carcinoma, Bronchogenic - surgery; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - surgery; Humans; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Neoplasm Invasiveness; Neoplasm Staging - methods; Pericardium - pathology; Pleural Neoplasms - secondary; Pneumonectomy - methods; Pulmonary Artery - pathology; Retrospective Studies; Thoracic Surgery, Video-Assisted - methods
• ISSN: 1579-2129
• DOI: 10.1016/j.arbres.2009.04.005

We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer. Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancer staging and assessment of resectability. When intrapericardial vessel involvement is suspected, exploration by videopericardioscopy (VPC) is also useful for assessing resectability in these cT4 cases. Up to December 2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In the remaining 46, it was performed as a result of EVT findings. We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients; thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases (10.2%) tumors were considered unresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinomatosis in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in 16 patients who were unable to tolerate pneumonectomy. In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17 cases), of the upper pulmonary artery and vein (6 cases), of the upper pulmonary artery and superior vena cava (2 cases), or of the left atrium and pulmonary veins (5 cases, in which the invasion was extensive). EVT and VPC as a first step in lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies.