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Year:
2000
| Volume: 8
| Issue: 2
| Pages: 45-46
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Original Article |
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THORACOTOMY INTRODUCING VIDEO-ASSISTED THORACOSCOPIC SURGERY IN BORDER-LINE CANDIDATES FOR SURGERY
Milos KOLEDIN, Dejan DJURIC, Bogdan MACEDONIC, Borislav BAROS |
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DOI:
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Abstract: |
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Background: Unlike an ordinary thoracoscopy, the video-assisted thoracoscopic surgery (VATS) enables a better exploration of the pleural region and mediastinum, thus providing a better insight in the tumor size and localization, as well as its interrelationship to other intrathoracic organs. Furthermore, VATS also secures a safer and better approach to the hilus of the lungs and mediastinum, enlightening the presence, size and localization of enlarged lymph nodes, as well as an involved perinodal tumor growth.
Materials and Methods: We have attempted an experimental investigation to find out whether VATS could introduce thoracotomy in border-line surgery candidates and thus increase the number of operable patients on one hand, and on the other decrease the number of explorative thoracotomies. In a four-years period we have performed thoracotomy introducing VATS in 64 border-line surgery candidates.
Results: Thirty patients avoided the explorative thoracotomy due to their inoperability confirmed by VATS. In 34 patients VATS was succeeded by thoracotomy which finally terminated as an exploration due to inoperability in only nine patients (in these patients a real insight into the tumor spread was unabled by adhesions). The other 25 patients were submitted to some kind of resection, although their tumor was over-staged and they would not otherwise have been operated on. Since the videothoracoscopic operability staging (VOS) was not applied in all surgery candidates but only in border-line cases, no significant decrease of the number of explorative thoracotomies has been achieved. Explorations indicated by carcinosis of the pleura without a pleural effusion may also account for this.
Conclusion: In our opinion, the routinely applied VOS may result in a significant decrease of explorative thoracotomies which could then be reserved for border-line cases where VOS is not applicable due to pleural adhesions. |
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Key words:
Video-assisted thoracoscopic surgery (VATS); Operability staging; Lung cancer; Explorative thoracotomy; Resectability |
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