Objective: To evaluate indications, limits, and merits of transxiphoid bila
teral palpation during video-assisted thoracoscopy (VAT) lung metastasectom
y.
Design: Survey retrospective study with a minimum follow-up of 1 year.
Setting: University hospital.
Patients: From December 1995 to September 1999, 29 of 45 patients operated
on for pulmonary metastasectomy were approached through a transxiphoid VAT.
Primary sites were colon-rectum(n=13), kidney (n=4), limb osteosarcoma(n=3
), uterus (n=2), larynx (n=2), breast (n=1), skin melanoma (n=1), prostate
gland (n=1), back fibrosarcoma (n=1), and ovary (n=1). Bilateral palpation
was performed in 23 patients, although only 10 had radiological evidence of
bilateral disease.
Results: No perioperative or 30-days postoperative mortality was recorded.
Acute and chronic pain was similar to that of other VATs and significantly
less than sternotomy. Mean+/-SD chest-drain time and hospital stay were 2.8
+/- 1.19 days and 4.3+/-1.78 days, respectively. Sixty-nine lesions, 60 of
them metastatic, were resected by laser (n = 29) or stapler (n=40). Bilate
ral exploration permitted the discovery of 15 radiologically undetected les
ions, 11 of which were found to be malignant. Contralateral metastases were
found in 5 patients predicted to have unilateral disease. Mean+/-SD follow
-up was 22.89 +/- 10.87 months (range, 9-60 months). Six patients developed
new pulmonary: metastases after a mean interval of 13.6 months; 3 of these
patients relapsed in the unexplored hemithorax after 6, 9, and 12 months,
respectively.
Conclusions: The use of the transxiphoid VAT approach was safe, applicable
in many instances, and effective in detecting occult metastases by manual b
ilateral palpation. The advantages of a VAT procedure can be coupled with t
hose provided by a radical operation.