VATS - INDICATIONS IN THE SURGICAL-TREATMENT OF MALIGNANT LUNG-DISEASE

VATS is able to perform by minimal access all operations known in gene ral thoracic surgery. Mortality (0,07 1,9 %) is low and complications (4,3 - 14,2 %) are rare, as published in four studies in the last two years. Especially long term results of VATS in malignant disease are n ot clear. Indications and limitations for VATS in bronchial carcinoma and lung metastases are discussed. Surgical treatment in peripheral no n-small cell lung cancer has best results after lobectomy. Limited res ection decreases the oncological result (5-year-survival-rate) by 10 t o 18% compared to lobectomy. Conservative treatment with radiotherapy in stage I carcinomas in patients who are not eligible for open lobect omy because of restricted lung function or other non oncological reaso ns has a bad prognosis (0-12 % 5-y-survival). In these cases VATS rese ction of bronchial carcinoma should by considered. Detection of all lu ng metastases by preoperative radiological study is only in 56 - 75 % possible. Between 10/93 - 2/98 we performed 52 thoracotomies for lung metastases at our surgical department. In eight cases bronchial carcin oma was confirmed by histological examination, nine patients with meta stases of malignant germ-cell-tumors were excluded from the study. CT- scan of the lung was performed preoperatively. In 43% of the cases (n= 35) additional lesions were detected intraoperatively by palpation of the lungs. Histopathologic examination revealed benign lesions in 9% a nd malignant in 34%. The result of lung metastases resection is highly dependent on the completness of extirpation. We therefore conclude th at lung metastases should be removed by open thoracotomy.