Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules

M. S. Allen, C. Deschamps, R. E. Lee, V. F. Trastek, R. C. Daly, P. C. Pairolero

Research output: Contribution to journalArticle

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Abstract

Between June 1991 and July 1992, 118 patients (57 men and 61 women) underwent video-assisted thoracoscopy for indeterminate pulmonary nodules. Median age was 64 years (range 30 to 85 years). Thoracotomy was performed in 33 patients (28.0%) after thoracoscopy only because the nodule could not be located in 17 patients, was too large to safely resect in 5, appeared malignant in 4, and for technical reasons in 7. Eighty-five patients underwent thoracoscopic wedge excision. Twenty-one (24.7%) of these 85 patients also had thoracotomy-15 to perform formal lung resection for bronchogenic carcinoma, 3 for nondiagnostic abnormalities, 2 to locate a second nodule, and 1 for stapler malfunction. The remaining 64 patients (54.2%) had only video-assisted thoracoscopic wedge excision. A single wedge excision was performed in 56 patients, two in 6, and three in 2. Pathologic examination of these 74 nodules revealed a granuloma in 30, metastatic cancer in 25, hamartoma in 7, lymphoma in 1, and other benign lesions in 11. There were no deaths and only 4 (6.3%) complications in these 64 patients. The 64 patients treated by thoracoscopy only were compared with a similar group of 64 patients who had wedge excision via thoracotomy without prior thoracoscopy. Postoperative analgesic requirements were less in the patients treated by thoracoscopy. Median hospitalization in the thoracoscopy group was 3 days compared with 6 days in the thoracotomy group (p < 0.05). Median total charge for the thoracoscopy-only group was $12,898 as compared with $12,502 for patients undergoing wedge excision via thoracotomy. We conclude that thoracoscopic wedge excision is a safe and effective procedure in selected patients with an indeterminate pulmonary nodule. A significant number of patients (45.8%), however, required a thoracotomy to accomplish a safe operation or to ensure adequate staging and resection for malignancy. Although thoracoscopy reduces postoperative analgesia requirements and shortens hospital stay, total hospital charges were similar to charges for a wedge excision via thoracotomy.

Original languageEnglish (US)
Pages (from-to)1048-1052
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume106
Issue number6
StatePublished - 1993

Fingerprint

Thoracoscopy
Lung
Thoracotomy
Hospital Charges
Hamartoma
Bronchogenic Carcinoma
Granuloma
Analgesia
Analgesics
Lymphoma
Length of Stay
Neoplasms
Hospitalization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Allen, M. S., Deschamps, C., Lee, R. E., Trastek, V. F., Daly, R. C., & Pairolero, P. C. (1993). Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. Journal of Thoracic and Cardiovascular Surgery, 106(6), 1048-1052.

Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. / Allen, M. S.; Deschamps, C.; Lee, R. E.; Trastek, V. F.; Daly, R. C.; Pairolero, P. C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 106, No. 6, 1993, p. 1048-1052.

Research output: Contribution to journalArticle

Allen, MS, Deschamps, C, Lee, RE, Trastek, VF, Daly, RC & Pairolero, PC 1993, 'Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules', Journal of Thoracic and Cardiovascular Surgery, vol. 106, no. 6, pp. 1048-1052.
Allen MS, Deschamps C, Lee RE, Trastek VF, Daly RC, Pairolero PC. Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. Journal of Thoracic and Cardiovascular Surgery. 1993;106(6):1048-1052.
Allen, M. S. ; Deschamps, C. ; Lee, R. E. ; Trastek, V. F. ; Daly, R. C. ; Pairolero, P. C. / Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. In: Journal of Thoracic and Cardiovascular Surgery. 1993 ; Vol. 106, No. 6. pp. 1048-1052.
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abstract = "Between June 1991 and July 1992, 118 patients (57 men and 61 women) underwent video-assisted thoracoscopy for indeterminate pulmonary nodules. Median age was 64 years (range 30 to 85 years). Thoracotomy was performed in 33 patients (28.0{\%}) after thoracoscopy only because the nodule could not be located in 17 patients, was too large to safely resect in 5, appeared malignant in 4, and for technical reasons in 7. Eighty-five patients underwent thoracoscopic wedge excision. Twenty-one (24.7{\%}) of these 85 patients also had thoracotomy-15 to perform formal lung resection for bronchogenic carcinoma, 3 for nondiagnostic abnormalities, 2 to locate a second nodule, and 1 for stapler malfunction. The remaining 64 patients (54.2{\%}) had only video-assisted thoracoscopic wedge excision. A single wedge excision was performed in 56 patients, two in 6, and three in 2. Pathologic examination of these 74 nodules revealed a granuloma in 30, metastatic cancer in 25, hamartoma in 7, lymphoma in 1, and other benign lesions in 11. There were no deaths and only 4 (6.3{\%}) complications in these 64 patients. The 64 patients treated by thoracoscopy only were compared with a similar group of 64 patients who had wedge excision via thoracotomy without prior thoracoscopy. Postoperative analgesic requirements were less in the patients treated by thoracoscopy. Median hospitalization in the thoracoscopy group was 3 days compared with 6 days in the thoracotomy group (p < 0.05). Median total charge for the thoracoscopy-only group was $12,898 as compared with $12,502 for patients undergoing wedge excision via thoracotomy. We conclude that thoracoscopic wedge excision is a safe and effective procedure in selected patients with an indeterminate pulmonary nodule. A significant number of patients (45.8{\%}), however, required a thoracotomy to accomplish a safe operation or to ensure adequate staging and resection for malignancy. Although thoracoscopy reduces postoperative analgesia requirements and shortens hospital stay, total hospital charges were similar to charges for a wedge excision via thoracotomy.",
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