Benefits of video-assisted thoracic surgery for repeated pulmonary metastasectomy.

Objective: The use of repeated pulmonary resection for metachronous pulmonary metastasis has increased. We assessed whether video-assisted thoracic surgery (VATS) produced greater benefits than classic thoracotomy for repeated pulmonary metastasectomy procedures.

Methods: A total of 46 patients who had undergone two or more pulmonary metastasectomies from 1995 to 2008 were analyzed in this study. These patients were classified into four groups as follows: group A (previous VATS/present VATS); group B (previous VATS/present thoracotomy); group C (previous thoracotomy/present VATS); group D (previous thoracotomy/present thoracotomy). The clinical features of these four groups were then compared.

Results: The operating time and the duration of thoracic drainage were longer in group D than in group A or B. The operating time was also longer in group C than in group A. Intraoperative bleeding was greater in group D patients than in other three groups. There were no discernible morbidities resulting from VATS in groups A or C. No differences were found in the occurrence of relapse among the groups. The mean interval from the previous to the present pulmonary metastasectomy also did not differ significantly among groups.

Conclusions: VATS can result in a shortened operating time, reduced intraoperative bleeding, and generally fewer complications compared with repeated classic thoracotomy. VATS is also potentially a curative procedure as it is not inferior to classic thoracotomy in terms of the relapse rate after repeated pulmonary metastasectomy.