P2.15-07 Bimanual Examination Is Indispensable in the Surgery of Lung Metastatic Tumors!

Abstract

Thoracic computed tomography (Th CT) is used to evaluate the surgical outcome of lung metastatic tumors. However, Th CT is often inadequate on the detection of millimetric lesions and it alone is a problematic for guiding complete resection. It is recommended for complete resection that the intraoperative bimanual palpation of the lung to be used with care and meticulously. In addition, there are studies for minimally invasive surgical methods may be an alternative to thoracotomy where bimanual evaluation is not possible. In this study, we aimed to evaluate the number of radiological and pathological metastases in patients who underwent metastasectomy with muscle conservative thoracotomy (MCT). Between 2008 and 2018, 204 patients with metastatic lung tumors who underwent metastasectomy were included in the Department of Thoracic Surgery, Ankara University Faculty of Medicine. Preoperative Th CT imaging of all patients was evaluated in a multidisciplinary council. The relationship between the numbers of metastases detected by pathological examination of patients and the number of pulmonary nodules reported as 'metastasis' in preoperative Th CT was retrospectively analyzed. 55% (n: 111) of the patients were F, 45% (n: 93) were M, mean age was 46.4 (13-77). %25 (n:52) of two hundred and four patients had bilateral, 3% (n: 8) of the patients had 3 and 1% (n: 4) of the patients had 4 metastasectomy with MCT due to contralateral lung metastasis or re-metastasectomy. The number of pulmonary nodules detected in Th CT was 740 (mean: 2,6), although the number of pulmonary nodules resected was 1503 (mean: 5,29). In histopathological evaluation of these nodules, 1120 (mean: 3,94) were reported as metastases. 2,03 fold of the nodules detected in Th CT were detected by bimanual intraoperative examination and 1.5 fold of nodules detected in Th CT were pathologically assessed as metastasis. Primary tumor numbers and histologies of 1120 metastatic nodules respectively; 42% (n: 475) were epithelial tumors and 58% (n: 645) were mesenchymal tumors. In this study, 740 pulmonary nodules were reported in Th CT of 204 patients. However, 763 additional pulmonary nodules were detected by bimanual palpation. 49.8% (380/763) of 763 additional pulmonary nodules were metastatic. Although minimally invasive surgery is a successful method for the surgery of many thoracic malignancies, bimanuel palpation of the lung with open surgery is still an effective method for the complete resection of pulmonary metastases. Bimanual examination is indispensable especially in the pulmonary metastasectomy of sarcomas.