Clinical Application for Video-Thoracoscopy in Lung Cancer Surgery Patients

Han, Jae Youl; Yoon, Yong Han; Baek, Wan Ki; Lee, Eung Sirk; Kim, Kwang Ho; Kim, Hyung Jin

Abstract

BACKGROUND: Video-thoracoscopy is known to be an useful method to provide accurate pre-resectional staging in patients with lung cancer in addition to the conventional radiologic studies and mediastinoscopy, for the pleural cavity is inspected directly and biopsy specimens can be obtained. This study is undertaken to evaluate how video-thoracoscopy can be used in deciding pre-resectional stage. MATERIAL AND METHOD: Video-thoracoscopy was performed in patients with lung cancer who were scheduled for surgical resection based on the radiologic staging and mediastinoscopic biopsy. 37 patients were included in this study. Pre-thoracoscopically 18 cases were in TNM stage 1, 7 in stage 2, and 12 in stage 3. RESULT: In 15 of 37 cases, video-thoracoscopy could not be performed effectively due to heavy adhesions in the pleural cavity, diaphragmatic and chest wall invasion of tumor and bulky tumor mass es. Mediastinal lymph nodes were positive postresectionally in 6 of these 15 cases. In 22 cases, video-thoracoscopy was performed as usual. Positive mediastinal lymph nodes were identified in 2 cases and exploratory thoracotomy was prevented. Surgical resection were carried out in remaining 20 cases and 5 cases among them had positive mediastinal lymph nodes.
CONCLUSION
We believe that it is difficult to perform pre-thoracotomy video-thoracoscopy for all lung cancer patients for there were many cases that thoracoscopy could not be undertaken due to heavy adhesions in the pleural cavity, tumor involvement of the chest wall and/or diaphragm and bulky tumor mass. However we think it is helpful in preventing unnecessary exploratory thoracotomy for some patients with lung cancer whom pre-thoracotomy video-thoracoscopy was carried out.