Impact of routine videothoracoscopy as the first step of the planned resectiona for lung cancer. Experience of 1306 cases

We have analyzed our experience of 1306 patients with NSCLC, submitted from November 1991 to December 2007 to routine videothoracoscopy exploration, as the first step of the planned procedure, in order to evaluate its validity in obtaining precise assessment of tumor extension, verifying thoracoscopic resectability and in decreasing the rate of unnecessary thoracotomies. Thoracoscopy revealed inoperability in 58 patients (4.4%) mostly due to pleural dissemination (2.4%) or mediastinal infiltration (1.7%). Of the remaining 1248 (95.6%), 449 (34.4%) had thoracoscopic resection (230 lobectomies, 6 pneumonectomies, 230 wedge resections), 767 (58.7%) underwent open resection (592 lobectomies, 175 pneumonectomies), and 32 (2.4%) had an exploratory thoracotomy (ET). Among the 32 ETs, thoracoscopy had suspected unresectability in 7 (0.5%), had been incompletely carried out in 4 early cases (0.3%) and had been unfeasible in 21 (1.6%). In our previous series from 1980 to 1991 the E.T. rate had been 11.6%. In the present series, after the introduction of routine thoracoscopy, the E.T. rate is 2.4% and the global rate of patients correctly staged, by thoracoscopy is 73.3%, significantly better than by CT. Video exploration resulted highly reliable in excluding conditions of unresectability with a negative predictive value (NPV) of 0.97. We conclude that preliminary thoracoscopy is useful in obtaining correct staging, reliably evaluates resectability of the lesion and helps in decreasing unnecessary thoracotomies.