EXPLORATORY THORACOTOMY FOR NONRESECTABLE LUNG-CANCER

We sought to evaluate the effect of new diagnostic modalities on patie nts explored surgically for inoperable lung cancer, From July 1983 to February 1992, 335 patients underwent thoracotomy for lung cancer, Thi rty-three of the 35 patients with nonresectable disease had sufficient data for analysis and underwent chest radiography (CXR), CT scan, and bronchoscopy. The study was terminated when video-assisted thoracosco py (VAT) was introduced at the institution, Causes of nonresectability included significant Na disease not diagnosed preoperatively (n=11), tumor invasion of contiguous mediastinal structures (n=8), and insuffi cient pulmonary function (n=4). Four patients were left with unresecte d disease because of thoracic metastasis, Two patients had technically unresectable disease; three patients were explored surgically because diagnoses could be obtained by no other means. One patient was found to have small cell, cancer, Data analysis demonstrated that 19 of 33 t horacotomies could potentially have been avoided or resulted in resect ion with current techniques, Refinement of imaging criteria, a judicio us surgical approach to N-2 disease, and VAT may significantly reduce thoracotomies for nonresectable lung cancer.