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

Commentary

Divisione di Chirugia Toracica, Instituto Europeo di Oncologia, Via Ripamonti, 435 20141 Milan, Italy

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

Top Staged axillary thoracotomy in... References

 
This nice paper proves the concept that various approaches can be used successfully to manage lung metastases with a limited invasive technique. In my view, there is no doubt that muscle-sparing thoracotomy is the gold standard for the unilateral open approach, and full posterolateral thoracotomy is almost never required for metastasectomy. Whether staged thoracotomy is better than median sternotomy, it's impossible to say in general. The two choices have different pros and cons. Median sternotomy remains an excellent approach for multiple peripheral metastases from sarcomas, while in epithelial cancer or germ cell tumours, bilateral staged thoracotomies may be a better and safer option, particularly if larger anatomical resections are warranted.

We have systematically used lateral muscle-sparing thoracotomy for the vast majority of thoracic procedures, including primary and secondary lung cancer, over the last 15 years [1] With the patient lying supine (oblique at 45°) or on his side and the arm suspended in the vertical position, the surgeon has full access to the axillary region and submammary sulcus. Personally, I have abandoned the vertical skin incision many years ago in favor of oblique incision along the intercostal space or submammary sulcus, which requires less skin mobilisation and gives better cosmetic results.

I believe that muscle-sparing thoracotomies (and not full posterolateral thoracotomy) represent nowadays the gold-standard to be compared with video-assisted thorascopic surgery (VATS) in proper randomised studies testing minimally invasive approaches to the chest.

	Footnotes

 
Presented at the 2nd MITSIG International Symposium: Controversies in Cardiothoracic Surgery, Hong Kong, November 20–21, 1998.

¹ Tel.: +39-2-5748-9665; fax: +39-2-5748-9208

	References

Top Staged axillary thoracotomy in... References

 

1. Pastorino U, Valente M, Muscolino G, Andreani S, Ravasi G. Muscle-sparing anterolateral thoracotomy for pulmonary or mediastinal resections. In: Motta G, editor. Lung cancer. Frontiers in science and treatment. Genoa: Grafica LP; 1994. pp. 337-341.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ugo Pastorino Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pastorino, U. Search for Related Content PubMed Articles by Pastorino, U.