The use of videoassisted thoracic surgery in lung cancer: evaluation of resectability in 296 patients and 71 pulmonary exeresis with radical lymphadenectomy.

OBJECTIVE To outline the usefulness of videothoracoscopic and videoassisted surgery in the final staging, resectability evaluation and treatment of lung cancer, and its possible advantages over thoracotomy. PATIENTS AND METHOD Videothoracoscopy was performed on 296 patients suffering from lung cancer. Patient selection criteria are described, as well as techniques for the different kinds of resections. Postoperative care and patient follow-up is also detailed. RESULTS Of the 296 patients 189 were operated on by open surgery after final staging and resectability evaluation. A total of 30 were considered unresectable by videothoracoscopic exploration, five cases needed exploratory thoracotomy to determine the resectability and in the remaining 72 cases the pulmonary resection was performed by videoassisted surgery: 21 pneumonectomies, five bilobectomies and 46 lobectomies. Three patients were rescued for surgery, after it was proven by intrapericardical videothoracoscopic exploration that the pulmonary artery was free at this level. The mean hospital stay was 48 h for the videothoracoscopic exploration and 6.8 days for the major lung resections. There were ten patients with complications (14%). The perioperatory mortality (30 days) was three cases (4.2%). The outcome (3-40 months follow-up) at the end of the study period was 62% patients alive and free of disease. DISCUSSION The applications of videothoracoscopic and videoassisted surgery in the treatment of lung cancer are considered: final staging, resectability evaluation, nodule biopsy and major resections with mediastinal lymphadenectomy. Their advantages include minimized pain, better cosmetic results, a shorter hospital stay and fewer complications.