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OBJECTIVE: To explore the safety and efficacy of a 2-staged approach to VATS - major pulmonary resection (VMPR) for presumed lung cancer in highly selected patients presenting with previous extra-thoracic adenocarcinoma and a fresh lung lesion. There is a tendency for interventional radiologist to omit the CT-guided needle biopsy and intraoperative frozen section could be non-contributory
METHODS: Patients undergoing first time VMPR for lung cancer were assessed within 2 groups: (A) patients with spiculate lesion, positive Computed Tomography and or Positron Emission Tomography and without preoperative histological diagnosis going straight to lobectomy or had intraoperative frozen section and Group (B) patients who had 2-stage VMPR i.e. initial VATS wide-margin wedge resection followed 2-4 weeks later by VMPR ± Systematic nodal dissection (SND). Lobectomy was considered inappropriate if final histology was benign or metastatic, and sublobar excision was possible
RESULTS: Between April 2005 and March 2010, 196 consecutive patients were considered for VMPR ± SND for presumed lung cancer in a Multidisciplinary setting. Group II had significantly more patients with another extra-thoracic cancer by design. Table 1 shows no difference in outcomes between the two groups. There was unacceptably high rate 74/169 (44%) of patients in Group I going straight to lobectomy without histological confirmation of malignancy. There were 10 (5.9%) unnecessary lobectomies in Group I, compared to none in Group II. There was no survival difference between the two groups
CONCLUSIONS: Every endeavour should be made to obtain preoperative histological diagnosis before VMPR to avoid unnecessary lobectomy, nodal dissection and to improve theatre-time utilisation. The two staged approach in selected cases is justified in a unit with a high throughput of VATS lobectomy. There is no additional morbidity or mortality to this approach. Principles of curative resection should not be compromised in this cohort of patients