Thoracic surgery has evolved throughout the decades. The difficulty of accessing the intrathoracic organs through the bony rib-cage has been a challenge for thoracic surgeons. In the past, large incisions stretching across the chest, such as posterolateral thoracotomies with rib spreading was the standard approach to access the lungs. These methods cause large amounts of trauma to the patient, with high rates of mortality and morbidity. However, with the advances in technology and the improvements in surgical technique, thoracic surgery has progressed to minimise trauma to the patient while still maintaining oncological and surgical principles. State-of-the-art technology, combined with wide variety of old and new surgical techniques give the thoracic surgeon a formidable armamentarium. Although there has been a focus on reducing the number and size of surgical wounds, considerations other than surgical approach can reduce the trauma suffered by the patient. Preservation of pulmonary function via organ preservation and anaesthetic techniques to further minimise the systemic inflammation such as non-intubated anaesthesia have also been shown to improve patient outcomes. This article aims to review the recent advances in minimally invasive thoracic surgery.
A potential limitation of integrated positron-emission tomography and computed tomography in non-small-cell lung cancer may be false-positive results due to granulomatous disease. This retrospective study examined the accuracy of this imaging modality for mediastinal nodal staging of non-small-cell lung cancer in Hong Kong where tuberculosis remains endemic. There were 249 lymph node stations evaluated in 107 patients, of whom 38 (36%) had active tuberculosis or evidence of previous tuberculosis. Imaging results were compared with histological findings. The sensitivity, specificity, and accuracy of integrated imaging for mediastinal nodal staging were 52%, 86%, and 80%, respectively; the overall positive-predictive value for mediastinal nodal metastasis was 46%, and the overall negative-predictive value was 89%. The positive-predictive value for mediastinal nodal metastasis was 39% in patients with tuberculosis and 50% in controls; the negative-predictive value was high in both groups (92% and 87%). The likelihood ratio for true positives was 6.47 in patients with tuberculosis vs. 10.97 in controls. This suggests that the reliability of positron-emission/computed tomography may be substantially poorer in patients with tuberculosis. Histological confirmation should be considered mandatory in patients with suspected metastasis on integrated imaging.
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