VIDEOTHORACOSCOPIC WEDGE RESECTION FOR PERIPHERAL PULMONARY NODULES

BACKGROUND: This study was done to evaluate the use of the endoscopic multifire linear stapler for videothoracoscopic wedge resection (VTWR) of peripheral pulmonary nodules and to define the indications, advant ages, and drawbacks of this minimally invasive technique. STUDY DESIGN : A case study review of 57 consecutive video-assisted thoracic operat ions for wedge resection of peripheral pulmonary nodules performed upo n 55 patients admitted to a community hospital from June 1991 through July 1993 is presented. RESULTS: There were 44 malignant and 13 benign lesions. Of the malignant peripheral pulmonary nodules (PPN), there w ere 19 adenocarcinomas, ten squamous cell carcinomas, two undifferenti ated large-cell carcinomas, three bronchoalveolar carcinomas, two carc inoid tumors, one neuroendocrine tumor, and seven metastatic carcinoma s. The benign nodules included five hamartomas, two granulomas, one as pergilloma, one nodular amyloidosis, one Wegener's granulomatosis, one focal pulmonary infarct, and two interstitial fibroses. Videothoracos copic wedge resection alone was performed upon 37 patients, 17 of whom had primary carcinoma of the lung; seven had metastatic lesions, and the remainder had benign disease. Of the 17 patients with primary carc inoma of the lung who had VTWR alone, eight patients had marked impair ment of pulmonary function, six had significant co-morbid disease, two had peripheral carcinoid tumors, and one had bilateral metachronous c arcinomas. Videothoracoscopic wedge resections with concomitant lobect omies were performed upon 20 patients with primary carcinoma of the lu ng, including one patient with bilateral synchronous carcinomas. Five of the patients with nodules ranging from 2 to 3 cm in diameter were f ound to have metastasis to regional nodes. None of the patients who ha d lobectomies for peripheral carcinomas less than 2 cm in diameter had regional nodal metastases. There was no perioperative mortality and n o significant morbidity. CONCLUSIONS: Videothoracoscopic wedge resecti on is a useful alternative to traditional transthoracic resection for suspicious, undiagnosed PPN, for low grade malignant neoplasms, such a s carcinoid, for peripheral metastatic lesions, for bilateral synchron ous or metachronous tumors, for the occasional clinically localized pe ripheral small-cell carcinoma as a surgical adjunct to chemotherapy, a nd for small, peripheral, T-1, N-0, M-0 bronchial carcinomas in compro mised patients at high risk with marginal pulmonary reserve. The proce dure is effective, minimally invasive, and has potential advantages ov er conventional thoracotomy, including less postoperative pain and mor bidity, shorter hospitalization period and convalescence, and an earli er return to work and normal activities.