Abstract

BackgroundVideo-assisted thoracic surgery (VATS) plays an important role in thoracic surgery because it is less invasive. However, the existence of severe pleural adhesions may make VATS difficult and complicated. The aim of this study was to assess the utility of inspiration and expiration computed tomography (respiratory dynamic CT (RD-CT)) in evaluation of pleural adhesions preoperatively.MethodsRD-CT was performed on 107 patients undergoing thoracotomies (both VATS and open). We assessed synchronous motion during respiration on RD-CT. Comparing the results of RD-CT and intraoperative findings, we assessed the utility of preoperative evaluation.ResultsA negative correlation between sliding score and adhesion grade was revealed. Sliding score in adhesion negative patients was significantly higher than that in adhesion positive patients (P < 0.0001). The sensitivity of RD-CT was 63.6%, specificity was 74.1%, and accuracy was 72%. Among 62 patients with a CT-Respiration Ratio of less than 0.65, the sensitivity of RD-CT was 77.8%, specificity was 86.8%, and accuracy was 85.5%.ConclusionsRD-CT may be clinically useful for detecting the presence of pleural adhesions. It can be adopted as one of the criteria for deciding the surgical approach.

Highlights

  • Video-assisted thoracic surgery (VATS) plays an important role in thoracic surgery because it is less invasive

  • Pleural adhesions between visceral and parietal pleura could increase the risk of lung injury and may require conversion to open surgery in cases with severe pleural adhesions, and it may result in prolongation of the operation time on VATS [1, 2]

  • There are some reports describing the usefulness of respiratory dynamic (RD) computed tomography (CT) [8, 9] or magnetic resonance imaging (MRI) [10–12] for detecting chest wall or aortic invasion by lung cancer

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Summary

Introduction

Video-assisted thoracic surgery (VATS) plays an important role in thoracic surgery because it is less invasive. The aim of this study was to assess the utility of inspiration and expiration computed tomography (respiratory dynamic CT (RD-CT)) in evaluation of pleural adhesions preoperatively. There are some reports describing the usefulness of respiratory dynamic (RD) CT [8, 9] or magnetic resonance imaging (MRI) [10–12] for detecting chest wall or aortic invasion by lung cancer. They evaluated the tumor location and its motion during respiration comparing the lung and chest wall or aorta. The aim of this study was to assess the utility of RD-CT for detecting pleural adhesions preoperatively

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