Prospective study on video-assisted thoracoscopic surgery in the resection of pulmonary nodules: 209 cases from the Spanish Video-Assisted Thoracic Surgery Study Group

• Published in: European journal of cardio-thoracic surgery 2001-05, Vol.19 (5), p.562-565
• Main Author: JIMENEZ, Marcelo F
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bronchoscopy; Diagnosis; Endoscopy; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung disease; Lung neoplasm; Lung Neoplasms - diagnosis; Lung Neoplasms - surgery; Male; Medical sciences; Middle Aged; Prospective Studies; Pulmonary coin lesion; ROC Curve; Sensitivity and Specificity; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - surgery; Thoracic Surgery, Video-Assisted; Video-assisted thoracic surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(01)00650-9

Objective: The diagnosis of pulmonary nodules has become one of the main indications of video-assisted thoracoscopic surgery (VATS), especially for small nodules not accessible by bronchoscopy or by percutaneous transthoracic needle aspiration. In this study we evaluate the indications, diagnostic safety, complications, and technical difficulty of VATS in the diagnosis of pulmonary nodules in Spain. Materials and methods: We conducted a prospective study of 209 patients with one or more pulmonary nodules from a group of Spanish thoracic surgery divisions (The Spanish Video-assisted Thoracic Surgery Study Group). Data was collected and evaluated on variables contained on a questionnaire including demographic information, characteristics of the nodules, identification methods, surgical technique, morbidity and mortality rates, and diagnostic yield. Results: The mean size of the nodules was 1.9 cm (range 0.3–5 cm). A total of 93.3% were peripheral. A diagnosis was established in 100% of the cases. In this study, 51.1% of lesions were benign and 48.8% were malignant. In 16.3% of cases, a conversion to thoracotomy was needed. The morbidity was 9.6% and the mortality 0.5%. We found a relationship between the size of a nodule and a diagnosis of malignancy (P=0.019) and between a central location and a need to convert to thoracotomy (P=0.002). Patients with nodules ≫2 cm had a greater risk of complications (P=0.0001). Conclusions: In the diagnosis of pulmonary nodules, VATS has a specificity of 100% and a low mortality rate. The probability of developing complications is higher when the nodule is ≫2 cm.