One-stop-shop diagnosis and surgical therapy for small nodules of early stage lung cancer in a hybrid theatre

Abstract

<b>Objective:</b> Lung cancer screening programs increased detection of small pulmonary nodules (SMP). Anatomical resection in case of early-stage lung cancer with only one intervention is desirable. Literature lacks data about both diagnosis and subsequent indicated resection. We reviewed the efficacy of detection, diagnosis and therapy in one step. <b>Methods:</b> SPM, which were not detectable by conventional video-assisted thoracoscopic surgery (VATS) due to localization and size, were scheduled for a hybrid procedure consisting of a cone-beam CT-guided hookwire insertion and C-arm assisted VATS wedge resection for frozen section. Analysis contained outcomes including success rate of image-guided resection and rate of concomitant correct anatomical resection. <b>Results:</b> Twenty-three patients with 25 nodules underwent image-guided VATS (iVATS). Twenty-two nodules were marked by hookwire, three nodules were detected by ultrasound in one case and palpation in two cases. In 16 patients (70%) frozen section showed malignancy. Five patients with previous history of operated lung cancer received only a diagnostic wedge, as frozen section could not differentiate between primary or metastatic lung cancer. Eleven patients (48%) had early-stage primary lung cancer. Ten of them (91%) received a synchronous completion anatomical resection. In one patient, malignancy was only confirmed in final histology. <b>Conclusion:</b> One-stop-shop diagnosis and treatment by iVATS with frozen section and concomitant completion anatomical resection in a hybrid operating room for otherwise non-well approachable early stage lung cancer is patient-convenient for the increasingly detected SMP.