Robert J. Cerfolio, Ayesha Bryant; Surgery, Univer of Alabama at Birmingham, Birmingham, AL
Objective: Video-assisted lobectomy (VATS) is an increasing used technique to treat patients with non-small cell lung cancer (NSCLC) but lung palpation is not usually performed.Methods: A prospective study on patients with VAT-able lesions (less than 4.5 cm and not central) who underwent open lobectomy via thoracotomy. All patients underwent helical CT scan with intravenous contrast and reconstruction at 5 mm intervals and had integrated FDG-PET/CT, 30 days or less prior to thoracotomy and resection. Unsuspected malignant pulmonary nodules that were palpitated and removed (from a different lobe than the one resected) and that were not imaged pre-operatively were defined as cancer that would have been missed by VATS lobectomy.
Results: From January 1, 2006 to September 1, 2006, one-hundred patients had VAT-able NSCLC lesions that were resected via thoracotomy by one surgeon. Eleven (11%) patients had malignant nodules that would have been missed by VATS lobectomy. These were unsuspected M1 pulmonary lesions in 6 patients and unsuspected different types of NSCLC primaries in 5 patients. All missed lesions were less than 6 mm and all were in different lobes than the one resected. Seven of the 11 patients' primary lesions were T1. Six patients received adjuvant chemotherapy because of the unsuspected pathologic M1 nodules.
Conclusion: Open lobectomy which affords palpation of the rest of the lung, may discover unimaged malignant pulmonary nodules in different lobes in 11% of patients with NSCLC despite preoperative, fine cut CT scan with contrast and integrated FDG-PET/CT scanning. The clinical impact of these findings is unknown.
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