VATS port site recurrence: A technique dependent problem

Objectives Video-assisted thoracic surgery (VATS) has become an accepted ap proach for the diagnosis and treatment of thoracic malignancies. Port site tumor recurrence is a reported complication of VATS. However, the true inci dence of this problem is unknown. To try to determine the incidence of port site recurrence, we analyzed our experience with patients undergoing VATS wedge resection for malignancy. Methods Data were obtained from our prospective VATS database. The analysis was confined to patients undergoing VATS wedge resection for malignancy, e xcluding those having a pleural biopsy only. Parameters analyzed included d emographic factors, surgical technique, and port site recurrences identifie d by physical examination, CT scan, or both. Results From 1992 to 1996, 410 patients (182 men, 228 women; median age = 6 1 years) underwent a VATS wedge resection for malignancy. The procedure was performed for diagnosis or staging in 90% of cases. Access incisions plus port sites were used in 97 (24%) patients; port sites only were used in 313 (76%) patients. Conversion to thoracotomy was necessary in 102 patients (2 5%) either for definitive resection (58 patients) or because VATS was not t echnically adequate (44 patients), Specimens were retrieved via access inci sions or port sites with or without a specimen bag. The operative mortality was 0.25%. With long-term follow-up (median = 25 months) available for 374 patients (91%), only one port site recurrence was identified (0.26%). Conclusion Our experience confirms the safety of VATS wedge resection in ca ncer patients. The incidence of port site tumor recurrence is low when onco logic principles are respected. In our institution, these principles includ e performing VATS wedge resection only for lesions that can be widely remov ed; converting to thoracotomy for definitive or extensive cancer operation; and using meticulous technique fur the extraction of specimens from the pl eural space.