Transxiphoid video-assisted pulmonary metastasectomy: Relevance of helicalcomputed tomography occult lesions

Background. The new transxiphoid video-assisted approach allows manual palp ation of both lungs, thus permitting better evaluation of helical computed tomography (CT) in detection of pulmonary metastases. Methods. From December 1995 to May 1999, 22 patients underwent a transxipho id video-assisted pulmonary metastasectomy. Manual palpation of both lungs was possible in 18 patients, whereas only 13 had radiologic evidence of uni lateral disease. Primaries were colon-rectum (n = 8), kidney (n = 3), uteru s (n = 2), larynx (n = 2), limb osteosarcoma (n = 2), and one each of breas t, skin melanoma, prostate, fibrosarcoma, and ovary. Results. No perioperative death occurred. Fifty-eight lesions, 49 metastati c, were resected, whereas only 46 had been predicted by helical CT scan. Tw elve occult lesions were discovered, eight of which were malignant. Overall sensitivity for proved metastases was 83.7% (41 of 49) and 75.8% (22 of 29 ) for those less than or equal to 5 mm. Mean follow-up was 15.27 months. On ly 2 patients had pulmonary relapse at 6 and 12 months. Conclusions. Despite helical CT, occult metastases may still be identified in almost one-third of the patients. The transxiphoid approach allows routi ne bilateral palpation and safe resection, and overcomes this critical limi tation of video-assisted metastasectomy. (Ann Thorac Surg 2000;70:1847-52) (C) 2000 by The Society of Thoracic Surgeons.