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J Thorac Cardiovasc Surg. 2008 Feb;135(2):261-8. doi: 10.1016/j.jtcvs.2007.08.062.

Is palpation of the nonresected pulmonary lobe(s) required for patients with non-small cell lung cancer? A prospective study.

Author information

1
Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala 35294, USA. Robert.cerfolio@ccc.uab.edu

Abstract

OBJECTIVE:

Video-assisted lobectomy is an increasingly used technique to treat patients with non-small cell lung cancer but it does not usually afford lung palpation.

METHODS:

A prospective study was conducted on patients with tumors amenable to video-assisted lobectomy (noncentral lesion and <5 cm) who underwent open lobectomy via thoracotomy. All patients underwent 64-slice helical computed tomographic scan with intravenous contrast at 5-mm intervals and had integrated 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography computed tomography 30 days or less before thoracotomy. Unsuspected malignant pulmonary nodules that were palpated and removed (from a different lobe than the one resected) and that were not imaged preoperatively were defined as cancer that would have been missed by video-assisted lobectomy.

RESULTS:

From January 2006 to February 2007, 166 patients had non-small cell lesions that were resected via thoracotomy, despite being amenable to video-assisted surgery, by one surgeon. Thirty-seven (22%) patients had pulmonary nodules that probably would have been missed by video-assisted lobectomy; 14 (8.4%) of these nodules were malignant. These were unsuspected M1 pulmonary lesions in 9 patients and unsuspected different types of primary non-small cell lung cancers in 5 patients. All missed lesions were less than 6 mm and in different lobes from the one resected. Nine (64%) of these 14 patients' primary known lesions were pathologic T1 lesions. Nine patients received adjuvant chemotherapy because of these unsuspected M1 nodules.

CONCLUSIONS:

Open lobectomy that affords palpation of the rest of the lung may discover nonimaged malignant pulmonary nodules in different lobes in 8% to 9% of patients with non-small cell lung cancer despite preoperative fine-cut chest computed tomographic scan with contrast and integrated integrated 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography computed tomographic scanning. The clinical impact of these findings is unknown.

PMID:
18242247
DOI:
10.1016/j.jtcvs.2007.08.062
[Indexed for MEDLINE]
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