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Routine surgical videothoracoscopy as the first step of the planned resection for lung cancer
The Journal of Thoracic and Cardiovascular Surgery, 06/19/09

Vergani C et al. - In a study to evaluate the validity of routine videothoracoscopy, performed as the first step of every planned resection for non–small cell lung cancer (NSCLC), to assess tumor resectability and feasibility of the resection through thoracoscopy, it apears that routine preliminary videothoracoscopy ensured assessment of tumor resectability and feasibility of the resection through thoracoscopy and limited unnecessary thoracotomies.

• From November 1991 to December 2007, 1306 pts with NSCLC, judged operable at conventional staging, underwent videothoracoscopy before the operation.

• Thoracoscopy revealed inoperability in 58 (4.4%) pts, mostly owing to pleural dissemination (2.5%) or mediastinal infiltration (1.7%).
• In the remaining 1248 (95.6%), thoracoscopy did not reveal inoperability.
• Of these, 449 (34.4%) underwent thoracoscopic resection; the other 799 (61.2%) underwent thoracotomy: 767 underwent resection, but 32 (2.5%) had an exploratory thoracotomy.
• Thoracoscopy had suggested unresectability in 7 (0.5%) pts, had been incompletely carried out in 4 (0.3%), and was unfeasible in 21 (1.6%) owing to insurmountable technical reasons.
• In a previous series from 1980 to 1991, exploratory thoracotomy rate had been 11.6%; in the present series, after introduction of routine thoracoscopy in the staging process, exploratory thoracotomy rate was 2.5%.
• Thoracoscopy was reliable in excluding unresectability (negative predictive value 0.97).
• Global percentage of correct staging was significantly better by thoracoscopy (73.3%) than by computed tomography (48.7%).
• Considering T descriptor, video-assisted thoracic surgery correctly matched with final pathologic staging in 96.2% of pts.

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