VIDEO-ASSISTED THORACOSCOPIC SURGERY FOR RESECTION OF LUNG METASTASES

Resection of indeterminate pulmonary lesions in patients with a histor y of malignancy is indicated, as the presence of metastases will provi de prognostic information and often dictate further therapy. Pulmonary metastasectomy also improves survival in select patients with favorab le tumor histologies. We reported the results of video-assisted thorac oscopic surgery (VATS) resection of indeterminate lung nodules in 72 p atients with a history of malignancy. All lesions identified on preope rative high-resolution CT scan were found at surgery with visual inspe ction, digital palpation, or (in 13 cases) CT-guided needle localizati on. All lesions were resected nonanatomically with a rim of normal par enchyma, as is done with open techniques; 63 patients were found to ha ve metastases and 9 patients had benign disease. There was no mortalit y, minimal morbidity, and decreased hospital stays in patients undergo ing VATS resection compared with historical control subjects. These da ta and other reports have led to the widespread use of VATS for patien ts undergoing resection to establish a diagnosis. The role of VATS in patients with favorable tumor histology and limited tumor burden for w hom metastasectomy may result in a survival advantage remains controve rsial. Improved image resolution with spiral CT scans and digital palp ation, combined with intraoperative ultrasound examination of the lung , may decrease or eliminate the number of lesions missed with a VATS a pproach. The role of therapeutic VATS metastasectomy remains to be def ined. Thus, this procedure currently should be used only in clinical t rials.