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.