Contribution of videothoracoscopy to the management of the cancer patient Journal Article

Authors: Rusch, V. W.; Bains, M. S.; Burt, M. E.; McCormack, P. M.; Ginsberg, R. J.
Article Title: Contribution of videothoracoscopy to the management of the cancer patient
Abstract: Background: Videothoracoscopy has rapidly become a popular procedure, but its technical feasibility has been emphasized without critically evaluating its role in the management of thoracic disease. To assess the value of videothoracoscopy in the diagnosis and staging of the cancer patient and to determine if it has added to our previous standard approach of thoracoscopy performed with a mediastinoscope without video, we established a prospective database when we initiated videothoracoscopy in January 1992. Methods: Patients were offered videothoracoscopy as an alternative to thoracotomy only if other standard approaches (e.g., needle biopsy, mediastinoscopy) were inadequate to diagnose or stage cancer or to restage patients after therapy. Parameters entered and analyzed in a prospective database were patient name; age; sex; past history; indications for videothoracoscopy; procedure type; surgical technique; whether conversion to thoracotomy was necessary, and if so, why; complications; and pathology. A complete case list of thoracoscopies performed in 1991 before videothoracoscopy was available provided historical comparison. Results: From January 1 to December 31, 1991, 82 patients underwent thoracoscopy using a mediastinoscope for diagnosis and therapy of pleural disease. From January 1 to July 31, 1992, 160 patients (male:female=81:79; mean age 56 years) had videothoracoscopy; 72 of 160 patients (44%) had procedures that previously would have required thoracotomy: 69 lung wedge resections, one pericardial window, one pleurectomy, one mediastinal node sampling. No major resectional procedures (e.g., lobectomy, esophagectomy) were performed by videothoracoscopy. Twenty-two percent of all patients (35 of 160), and 23% of wedge resection patients (16 of 69) required conversion to thoracotomy because videothoracoscopy was inadequate for diagnosis or staging. Reasons for conversion (multiple reasons in five patients) included further resection required in 23 patients; inability to evaluate lesion in 11; adhesions in five; and inability to tolerate one lung ventilation in two. The chest tube was in place postoperatively for a mean of 2.3 days. Thirty-day postoperative complications included ventilation for >48 h in one patient; prolonged air leak in one; pneumonia in one; arrhythmia in one; and death from progressive disease in two. Conclusions: Although the role of videothoracoscopy in the treatment of primary thoracic malignancies and pulmonary metastases is still undefined, this early experience indicates that videothoracoscopy often enhances the ability to diagnose and stage patients by obviating thoracotomy. © 1994 The Society of Surgical Oncology, Inc.
Keywords: adult; aged; aged, 80 and over; staging; cancer diagnosis; videorecording; thoracic neoplasms; thorax surgery; thorax tumor; thoracoscopy; middle age; video recording; thoracic surgery; human; male; female; article; videothoracoscopy
Journal Title: Annals of Surgical Oncology
Volume: 1
Issue: 2
ISSN: 1068-9265
Publisher: Springer  
Date Published: 1994-03-01
Start Page: 94
End Page: 98
Language: English
DOI: 10.1007/bf02303550
PROVIDER: scopus
PUBMED: 7834446
Notes: Export Date: 14 January 2019 -- Article -- Source: Scopus
Citation Impact
MSK Authors
  1. Valerie W Rusch
    739 Rusch
  2. Robert J Ginsberg
    178 Ginsberg
  3. Manjit S Bains
    268 Bains
  4. Michael E. Burt
    183 Burt