The use of video-assisted thoracic surgery in the management of Pancoast tumours.

We describe our experience using video-assisted thoracic surgery (VATS) as an adjunct to the surgical management of Pancoast tumors. 30 Between March 2004 and November 2009, 13 patients with Pancoast tumors were included in this study. Surgery was performed by 31 positioning the patient to allow either an anterior or a posterior thoracotomy. VATS was employed to explore the pleural cavity, to optimize 32 the surgical access and as an assistance during surgical resection. Three patients with pleural carcinosis at thoracoscopy did not undergo 33 further surgery. Seven lobectomies and three wedge resections were performed with an en bloc chest-wall resection and mediastinal 34 lymphadenectomy. The surgical approaches were a transmanubrial L-shaped incision (ns1), a posterior thoracotomy (ns8), and a combined 35 transmanubrial and posterior thoracotomy (ns1) which were dictated by the thoracoscopic findings. The average operative time was 36 200 min (range: 185–280 min); the average blood loss was 325 ml (range: 250–1200 ml). The average hospitalization was nine days (range: 37 8–30 days). Our study indicates that VATS may be an effective and safe adjunct to standard surgical resection in patients with Pancoast 38 tumors. It reduces the magnitude of surgery, either by sparing the patient a useless thoracotomy or, by optimizing the site of the 39 thoracotomy. It may also have a significant educational role. 40 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.