MIDTERM RESULTS OF THORACOSCOPIC SURGERY FOR PULMONARY METASTASES ESPECIALLY FROM COLORECTAL CANCERS

Indications for thoracoscopic metastatectomy remain controversial beca use not all metastatic tumors may be detected without the manual palpa tion that is possible with thoracotomy. However, the accuracy (92%) of preoperative lung imaging in patients with one or two lesions led us to re-evaluate thoracoscopic metastatectomy with patient survival as t he primary end point. Thoracoscopic wedge resection using an endoscopi c stapling device or video-assisted thoracic surgery (VATS) lobectomy was performed in patients with one or two pulmonary metastases, Thorac oscopic resection was performed in 27 patients with 22 solitary lesion s and 5 patients with two lesions. The primary tumors were colorectal cancer (15), testicular cancer (3), osteosarcoma (2), and seven other histologies, In 5 of 27 patients (18.5%) a thoracoscopic operation was converted to a VATS procedure, which requires minithoracotomy to iden tify metastasis primary by digital palpation. The 3-year survival rate for colorectal cancer patients who underwent thoracoscopic resection was 56.4%, in comparison to 48.6% in historical control thoracotomy pa tients (n = 16), There was no statistically significant difference bet ween the two groups. Thoracoscopic resection of one or two colorectal cancer lung metastases results in a survival rate similar to standard thoracotomy, and thereby provides an acceptable alternative to this mo re invasive approach.