Tumor dissemination after thoracoscopic resection for lung cancer

Abstract

Many peripheral nodules of the lung that cannot be determined to be benign by means of radiographic assessment require resection to rule out malignancy. The rapid evolution of minimally invasive surgical techniques is stimulating new technical and surgical innovations. Growing enthusiasm for these minimally invasive surgical procedures has led to an expanded role for thoracoscopic or video-assisted thoracic surgery for the solution of many intrathoracic surgical problems. Thoracoscopic surgery has expanded from a rarely used technique for the evaluation of benign diseases to an operative approach used in the treatement of lung cancer. At this writing, there have been reports of nearly 100 thoracoscopic or video-assisted resections in ~Lhe treatment of lung cancer. 1 2 In January 1990, we began to perform thoracoscopic operations in our Department for General and Thoracic Surgery in Giessen, Germany. Since January 1992, we have elected a thoracoscopic approach for some nodules of the lung because of our good experiences with thoracoscopic wedge resection for such benign diseases as pneumothorax. Although the decrease in postoperative pain is obvious in the early period after operation, 3 there remains concern about oncologic aspects of this approach. We therelore report on two cases of tumor dissemination after thoracoscopic resection for lung cancer. In 63 cases, nodules were resected by thoracoscopic wedge resection. In 21 cases, malignancy was demonstrated (14 metastases and seven primary lung cancers). In two of these patients, tumor cell dissemination was observed. Case 1. In July 1992, we treated a patient who had bad lung function and a peripheral nodule (1.5 cm diameter on computed tomographic scan) of the right upper lobe by means of thoracoscopic wedge resection. The histologic examination showed an adenocarcinoma without infiltration of the pleura visceralis (pathologic classification Tl, grade 2). By means of intraoperative pleural lavage, we found tumor cells remaining after the thoracoscopic resection. In February 1994, we detected a metastatic nodule (3 cm in diameter) at the site in the chest wall where the tumor was extracted during the thoracoscopic operation. On computed tomographic scan, we did not find any tumor recurrence in the lung. We performed a curative resection of the tumor located at the thoracic wall. One year after the operation, the patient was in good condition and remained free of any other tumor manifestations.