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

We describe our experience using video-assisted thoracic surgery (VATS) as an adjunct to the surgical management of Pancoast tumors. Between March 2004 and November 2009, 13 patients with Pancoast tumors were included in this study. Surgery was performed by positioning the patient to allow either an anterior or a posterior thoracotomy. VATS was employed to explore the pleural cavity, to optimize the surgical access and as an assistance during surgical resection. Three patients with pleural carcinosis at thoracoscopy did not undergo further surgery. Seven lobectomies and three wedge resections were performed with an en bloc chest-wall resection and mediastinal lymphadenectomy. The surgical approaches were a transmanubrial L-shaped incision (n=1), a posterior thoracotomy (n=8), and a combined transmanubrial and posterior thoracotomy (n=1) which were dictated by the thoracoscopic findings. The average operative time was 200 min (range: 185-280 min); the average blood loss was 325 ml (range: 250-1200 ml). The average hospitalization was nine days (range: 8-30 days). Our study indicates that VATS may be an effective and safe adjunct to standard surgical resection in patients with Pancoast tumors. It reduces the magnitude of surgery, either by sparing the patient a useless thoracotomy or, by optimizing the site of the thoracotomy. It may also have a significant educational role.