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Eur J Cardiothorac Surg 1999;16:S13-S16
© 1999 Elsevier Science NL

Pulmonary metastases: biologic and historical justification for VATS

Division of Thoracic Surgery, University of Maryland Hospital, 22 South Greene Street, Rm N4W94, Baltimore, MD 21201, USA

Key Words: Pulmonary metastases • Video-assisted thoracic surgery

The first 300 words of the full text of this article appear below.

Surgical resection has come to be accepted as standard treatment for patients with isolated pulmonary metastases. Although no prospective studies have ever been performed to clearly assess the benefit of pulmonary metastasectomy, there is an abundance of retrospective data that indicates long term survival benefits of complete pulmonary metastasectomy over historical controls without resection. This data has been used to support aggressive unilateral and bilateral open explorations for resection. Despite this aggressive approach, there is still a recurrence rate of over 50%. However, the long term survival of patients undergoing repeat metachronous metastasectomy has been unchanged compared to patients who did not require repeat metastasectomy after primary resection. Thus, patients with pulmonary metastases may face multiple surgical explorations with ‘curative' intent. These patients may be ideally suited to have their pulmonary resections performed with the aid of minimally invasive video assisted thoracic surgical techniques.

Concurrently, the techniques, indications and training of video-assisted thoracic surgery (VATS) have significantly developed. A number of surgeons have begun to apply VATS procedures to patients with pulmonary metastases in both diagnostic and therapeutic settings. Other surgeons, however, oppose the use of VATS as a therapeutic modality. To date, no prospective or significant retrospective data exist to support either opinion. Currently, the National Cancer Institute (NCI) sponsored US inter-group trial is conducting a Phase III multinational cooperative study comparing open resection (thoracotomy or median sternotomy) to minimally invasive (video-assisted) resection. The primary objective will be to determine the overall, failure-free survival difference between VATS and open approaches in the treatment of pulmonary metastases. It is the groups hypothesis that VATS resection will yield the same disease-free survival as open approach but with less overall morbidity, cost and pain to the patient. This will allow surgeons and oncologists, for the first time, to prospectively study the prognostic . . . [Full Text of this Article]

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