PURPOSE: Pulmonary lesions were difficult in confirming their characters by clinical imaging, small amount or unreliable specimens. Total excision of highly suspected small pulmonary lesions through video-assisted thoracic surgery (VATS) can be used for specific diagnosis and definite therapy, even for some of early peripheral pulmonary carcinomas. Preoperative localization, which can be achieved by percutaneous CT-guided hook wire insertion or microcoil insertion, will be most useful for patients undergoing VATS resection with small or deeply seated pulmonary lesions.
METHODS: From May 2007 to January 2010, 27 patients with small (<1cm in diameter) or deep-seated (<2cm in diameter but >1cm from pleural surface) lung lesions, which cannot exclude the possibility of malignancies by clinical imaging or cannot harvest reliable specimens from needle aspiration or biology, were included in this study. CT-guided hook wire insertion was performed under local anesthesia. Resection of pulmonary lesion was performed through VATS after localization and transferring to the operating room.
RESULTS: Complete resections of these lesions were performed through VATS. There were seven patients (26%) undergoing second procedures, including wider margin of resection (2 patients), segmentectomy (2 patients) and lobectomy (3 patients) with lymph node dissection (in 4 of these 5 patients undergoing segmentectomy or lobectomy) through VATS or open thoracotomy (2 of the lobectomy patients), due to primary pulmonary carcinoma being diagnosed on frozen section. There were additional two patients (7.5%) with small pulmonary ground glass opacity (GGO) lesions without evidence of lymph node involvement undergoing simple wedge resection only. Metastatic lesions were diagnosed in seven (26%) of them. Eleven (41%) of them were diagnosed as benign lesions. No major complications were noted in these cases.
CONCLUSION: Resection of unknown pulmonary lesions through VATS for selective patients can be helpful in their early and reliable diagnosis as well as minimally invasive and effective treatment. Pre-operative CT-guided localization can facilitate subsequent resection and avoid possible open procedures.
CLINICAL IMPLICATIONS: A new method for early diagnosis and treatment for undetermined pulmonary nodule.
DISCLOSURE: Shi-Ping Luh, No Financial Disclosure Information; No Product/Research Disclosure Information