Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy (A Report of 129 Cases)
10.3779/j.issn.1009-3419.2017.01.05
- VernacularTitle:胸腔镜治疗肺部微小结节（129例报告）
- Author:
WANG TONG
1
;
YAN TIANSHENG
;
WAN FENG
;
MA SHAOHUA
;
WANG KEYI
;
WANG JINGDI
;
SONG JINTAO
;
HE WEI
;
BAI JIE
;
JIN LIANG
Author Information
1. 北京大学第三医院胸外科
- Keywords:
Lung neoplasms;
Video-assisted thoracic surgery;
Ground glass opacity
- From:
Chinese Journal of Lung Cancer
2017;20(1):35-40
- CountryChina
- Language:Chinese
-
Abstract:
Background and objective hTe development of image technology has led to increasing detection of pulmonary small nodules year by year, but the determination of their nature before operation is diffcult. hTis clinical study aimed to investigate the necessity and feasibility of surgical resection of pulmonary small nodules through a minimally invasive approach and the operational manner of non-small cell lung cancer (NSCLC). Methods hTe clinical data of 129 cases with pulmonary small nodule of 10 mm or less in diameter were retrospectively analyzed in our hospital from December 2013 to November 2016. hTin-section computed tomography (CT) was performed on all cases with 129 pulmonary small nodules. CT-guided hook-wire precise localization was performed on 21 cases. Lobectomy, wedge resection, and segmentectomy with lymph node dissection might be performed in patients according to physical condition. Results Results of the pathological examination of 37 solid pulmonary nodules (SPNs) revealed 3 primary squamous cell lung cancers, 3 invasive adenocarcino-mas (IAs), 2 metastatic cancers, 2 small cell lung cancers (SCLCs), 16 hamartomas, and 12 nonspeciifc chronic inlfammations. hTe results of pathological examination of 49 mixed ground glass opacities revealed 19 IAs, 6 micro invasive adenocarcinomas (MIAs), 4 adenocarcinomas in situ (AIS), 1 atypical adenomatous hyperplasia (AAH), 1 SCLC, and 18 nonspeciifc chronic in-lfammations. hTe results of pathological examination of 43 pure ground glass opacities revealed 19 AIS, 6 MIAs, 6 IA, 6 AAHs, and 6 nonspeciifc chronic inlfammations. Wedge resection under video-assisted thoracoscopic surgery (VATS) was performed in patients with 52 benign pulmonary small nodules. Lobectomy and systematic lymph node dissection under VATS were performed in 33 patients with NSCLC. Segmentectomy with selective lymph node dissection, wedge resection, and selective lymph node dissection under VATS were performed in six patients with NSCLC. Two patients received secondary lobectomy and systematic lymph node dissection under VATS because of intraoperative frozen pathologic error that happened in six cases. Two cases of N2 lymph node metastasis were found in patients with SPN of IA. Conclusion Positive surgical treatment should be taken on patients with persistent pulmonary small nodules, especially ground glass opacity, because they have a high rate of malignant lesions. During the perioperative period, surgeons should fully inform the patients and family members that error exist in frozen pathologic results to avoid medical disputes.
