Contribution of video-thoracoscopy to the pre-treatment evaluation of lungcarcinoma

Introduction. - Lung cancer is the first cause of cancer mortality in male patients in France. Treatment varies depending on the histological type and the disease extent at diagnosis. Current knowledge and key points. - Videothoracoscopic staging appears to b e an accurate method to assess the stage of lung cancer to guide rational m anagement as it allows for 1) an accurate tissue diagnosis when standard me thods failed, 2) the identification of a parietal or mediastinal invasion w hen suspected by CT-scan findings, 3) lymph node sampling of sites that are poorly or not reachable with mediastinoscopy, 4) the diagnosis of pleural or pericardial metastases in patients with effusion or indeterminate nodule s, and finally 5) the conclusive answer to the diagnostic dilemma caused by the presence of a contralateral pulmonary nodule in patients with a potent ially curable tumor. Future prospects and projects. - Video-assisted thoracoscopy thus appears t o have a complementary role in intrathoracic lung cancer staging when conve ntional methods are equivocal. Its main side-advantage is the opportunity t o proceed without delay to the surgical treatment, when appropriate, in the same operative settings, or to perform in the same session various procedu res, i.e., talc poudrage and pericardial window, to palliate adverse sympto ms occurring in some of those patients. Obviously, equally efficient and le ss invasive approaches should have been considered previously. To date, how ever, videothoracoscopic evaluation of tumor resectability is not achievabl e. Finally, one may suppose that positron emission tomography will probably reduce the role of those invasive surgical procedures in a near future. (C ) 1999 Editions scientifiques et medicales Elsevier SAS.