Department of Surgery MSc defense on Friday, October 16th. 2:00 PM in the Department of Surgery Seminar Room.
All are welcome to attend !!
Candidate: Dr. Omamah AlMousa Supervisor: Dr. Richard Finley
Thesis : Image-guided video-assisted thoracic surgery excision of small peripheral pulmonary nodules in patients with previous extra-thoracic malignancies
Abstract
OBJECTIVE: The purpose of this study is to determine the utility of preoperative CT-guided microcoil localization (CTML) followed by fluoroscopy guided VATS resection in the diagnosis and management of SPPN in patients with extra-thoracic malignancies.
METHODS: This study was a retrospective analysis of prospectively collected data. Between August 2003 and September 2013, 50 patients with a cumulative history of 14 different extra-thoracic cancers underwent preoperative localization of undiagnosed SPPN using percutaneously placed CT-guided platinum microcoils (CTML). Coils were placed with the distal end deep to the nodule and the superficial end coiled on the visceral pleural surface. Nodules were removed by VATS wedge excision using endostapler with visualization by intraoperative fluoroscopyh and VATS.
RESULTS: A total of 50 patients with a cumulative history of 14 different extra-thoracic cancers (57% female, mean age 62 years) had 55 nodules resected (mean size = 12.11 mm, depth from visceral pleura = 22.07 mm), using CTML and fluoroscopic guided VATS wedge excision. The previously treated extra-thoracic tumor sites were colorectal (16), breast (9), renal (4), sarcoma (5), melanoma (3), lymphoma (3), thyroid (3), prostate (2), gastro esophageal (2), cervix (2), bladder (1), others (3). Nodule histology showed metastasis (25/50 patients), benign (11/50) and (15/50) new Stage 1 primary lung cancer. The mean time interval between the diagnosis of the primary tumor and the finding of pulmonary nodule(s) was 76.7 months (range 4–588). On logistic regression analysis, lung nodules in smokers were found 6 times more likely to represent primary lung cancer than metastasis (p 0.009). Further, non-smokers were found 15 times more likely to present with benign lesions (p 0.02). The preoperative localization with CTML procedure was done successfully in all patients with a mean time of 31.5 +/- 10. This procedure allowed successful diagnostic VATS wedge resection in all cases and was therapeutic for half of the cases. The mean time of VATS operation and fluoroscopy were 26.68 minutes +/- 12.4 and 1.35 minutes +/-5.93, respectively. There were no clinically significant complications related to the coil placement, or surgical resection. After a follow up period of 35 months, all patients were alive and none of the patients had local recurrence of disease.
CONCLUSIONS: Pre-operative localization of small peripheral pulmonary nodules using percutaneous CT-guided microcoil localization followed by fluoroscopic guided VATS resection changed the management and improved the prognosis in 50% of patients with presumed metastasis with minimal morbidity. The 20% of patients with benign disease required no further therapy while the 30% of patients with Stage 1 primary lung cancer underwent curative surgical resection. Pulmonary nodules in patients with extra-thoracic malignancy have an equal chance of being metastatic versus non-metastatic lesions. The utilized localization procedure followed by fluoroscopy guided VATS proved to be effective in achieving early definitive diagnosis and decide upon a therapeutic strategy.
posted : 2015-October-13