Initial single-port thoracoscopy to reduce surgical trauma during open en bloc chest wall and pulmonary resection for locally invasive cancer

Abstract

Minimally invasive techniques aid to delineate the boundaries of chest wall involvement of lung cancer and intraoperative staging. This helped tailoring the surgical approach and location of the thoracotomy, and prevented rib-spreading or additional thoracotomies in our cases.

A comparative analysis of Pancoast tumour resection performed via video-assisted thoracic surgery versus standard open approaches

“…VATS confirmed chest-wall invasion when suspected on computed tomography (CT) scan, and determined the boundaries and location of the chest-wall involvement. It allowed placing of the incision over the involved area, proceeding with accurate excision of the chest wall without the need for extensive thoracotomies, and to proceed with pulmonary resection en bloc only through the space available after the rib excision without the need for rib spreading or extending of the thoracotomy [1]. Similar results were previously obtained by the authors in the management of Pancoast tumours [2].…”

“…VATS reduced surgical trauma and maintaining oncological principles of traditional open procedures. Recently, in a multicentre study, Bayarri et al [1] reported its use during open en bloc chest-wall and pulmonary resection for locally invasive cancer. VATS confirmed chest-wall invasion when suspected on computed tomography (CT) scan, and determined the boundaries and location of the chest-wall involvement.…”

Video-assisted thoracoscopic surgery lobectomy with chest wall resection

“…Pulmonary complications were the most common cause of death in patients who underwent chest wall resection and reconstruction (41). We believe that less invasive procedures may help decrease early complications and, therefore, provide better short-term results (38).…”

“…The extent of surgical resection depends on the depth of invasion and the tumor location. For tumors limited to the parietal pleural, extrapleural resection keeping the chest wall intact is sufficient to achieve complete resection with long-term survival (2,38). In cases of isolated parietal pleura invasion, chest wall resection does not convey any survival advantage (2).…”

Single-port video-assisted thoracic surgery (VATS)—advanced procedures & update

“…The decision to perform a VATS approach in a resectable chest wall invasion lung cancer arises from the perception that perturbing the rib cage with a smaller incision, avoiding rib spreading and the incision of other chest wall tissue, will have a better outcome, with less postoperative pain, with the same oncologic results as with an open surgery (23,24). Afterwards, a large number of thoracoscopic lobectomies with rib resection were performed using 3 to 4 incisions (25).…”