ROLE OF VIDEO-ASSISTED THORACIC-SURGERY IN THE TREATMENT OF PULMONARYMETASTASES - RESULTS OF A PROSPECTIVE TRIAL

Background. A retrospective review revealed a 42% error rate between c omputed tomographic scan reports and thoracotomy findings; therefore, a prospective study was designed to compare the value of computed tomo graphic scans, video-assisted thoracoscopic exploration, and open thor acotomy in the management of pulmonary metastases. Methods. Eligibilit y included any patient with only one or two ipsilateral pulmonary meta stases identified on computed tomographic scan who was being considere d for surgical resection. Initially video-assisted thoracic surgery wa s performed and all lesions identified were resected. A thoracotomy ad equate for complete lung palpation was then carried out and any additi onal lesions found were removed. Results. Eighteen patients of a plann ed 50 were treated before closure of the study. Four patients (22%) ha d no additional lesions found at thoracotomy. The primary sites of tum or were colon (10), breast (3), and one patient each skin (squamous), cervix, kidney, melanoma, and sarcoma. Four patients (22%) did have ad ditional lesions at thoracotomy, which were benign. In the remaining 1 0 patients (56%) additional malignant lesions were found at thoracotom y after video-assisted thoracoscopic exploration. After 18 patients we re entered, analysis of the early results disclosed a 56% failure rate of a computed tomographic scan and video-assisted thoracic surgery to detect all lesions. Being within the 95% confidence interval (32% to 78%), the study was abandoned. Conclusions. We conclude that video-ass isted thoracic surgery should be used only as a diagnostic tool in man aging lung metastasis. A thoracotomy is required to achieve complete r esection, which is the major survival prognosticator for satisfactory long-term results.