The aim of our work was to evaluate the role of VATS in mediastinal lymph nodal biopsies for staging lung cancer. When pre-operatively staging lung cancer, it is very difficult to evaluate sure lymph node involvement, but lymph node invasion and the degree of infiltration are factors conditioning the therapy choice. VATS permits to effect mediastinal nodes biopsies unlikely accessible at mediastinoscopy such as subaortic nodes, paraaortic, subcarinal posterior, paraesophageal and pulmonary ligament nodes.
From 1995 to 2004, 78 patients were submitted to VATS for mediastinal lymphonodal biopsy. The goal of biopsy was staging lung cancer. Seventy-six patients underwent lymph nodal thoracoscopic biopsy (97%), while in 2 histology was done by pleural metastatic nodule thoracoscopic biopsy (3%). We performed 27 lymph nodal biopsies in level 5 (34%), 22 in level 6 (28%), 20 in level 7 (26%) and 7 in level 8 (9%). In 63 cases lymph nodal biopsy was ipsilateral (81%) while in 13 contralateral (16%).
No post-operative complications were observed and 26 subjects (33%), whose lymph node specimens showed no evidence of neoplastic cells at extemporary analysis, underwent to open lung resection in one time. Histology was adenocarcinoma in 38 cases (49%), squamous carcinoma in 21 (27%), microcitoma in 11 (14%) and giant-cell lung carcinoma in 8 (10%). Fifteen patients were at stage I (19%), 11 at stage II (14%) and 50 at stage III (64%). These last subjects received neoadjuvant chemotherapy or chemotherapy and/or radiotherapy. Two patients at stage IV (3%) underwent to definitive chemotherapy.
VATS seems to be a safe and effective technique for diagnosis, staging and treatment of lung cancer patients. Our results indicate that it allows adequately sized lymphonodal specimens to be taken for histological typing and treatment decision making. It is not very invasive and led to a low incidence of complications.
Vats permits to obtain a surely diagnosis in lung cancer linfonodal biopsies in all the station difficulty to reach by mediastinoscopy.
P.P. Brega-Massone, None.