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Eur J Cardiothorac Surg 1999;16:S37-S39
© 1999 Elsevier Science NL

Staged axillary thoracotomy for bilateral lung metastases: an effective and minimally invasive approach

General Thoracic Surgery, Catholic University of Rome (Divisione di Chirurgia Toracica, Università Cattolica del Sacro Cuore), Largo Agostino Gemelli, 800168 Rome, Italy

^* Corresponding author. Tel.: +39-06-3015-4166; fax: +39-06-3051-162 (Email: stemargaritora{at}yahoo.com).

Objective: We describe our experience with the staged axillary thoracotomy (SAT), for the treatment of bilateral lung metastases. Materials and Methods: Between January 1995 and June 1998, 75 lung metastasectomies were carried out in our institution, 49 (65%) monolateral, and 26 (35%) bilateral. In the latter group of patients we adopted a staged axillary thoracotomy. Results: All wedge resections and two lobectomies (1 LUL and 1 RLL) were performed through this approach. Resection has been complete in all patients. Histology was epithelial in 15 (57%), sarcoma in nine (35%) and germ cell in two (8%). Two to three metastases have been resected in 10 patients (38%); four to 10 in 12 patients (46%) and over 10 in four patients (15%). The radiological pre-operative assessment was accurate in 15 patients (57%), underestimated in nine (35%) and overestimated in two (8%). The average interval between the two procedures has been 24±6 days. The average operation duration time was 50 min (range 36–67). We do not report any post-operative death or major complication. The average hospitalization was 3.2 days (range 2–6) for each single procedure and 6.2 days (range 4–10) for both procedures. Conclusion: This technique is adequate, fast and safe and did not affect the shoulder girdle motion at all providing an excellent cosmetic outcome. The operative trauma is limited and a minor post-operative pain is present. A shortening of the interval between the two operations is allowed.

Key Words: Lung metastases • Surgery • Axillary thoracotomy • Muscle sparing