Dinjens, L. (2015) Pre-operative CT-guided hookwire localisation: A way to increase the efficacy and safety of the VATS-procedure of pulmonary nodular lesions. thesis, Medicine.
Full text available on request.Abstract
Introduction: Lung cancer is the most common cause of cancer related death in the world. Because of the high incidence and high mortality, lung cancer is and will be a subject of interest for research and in need of new diagnostic and treatment options. With the introduction of computed tomography (CT) screening for lung cancer in high-risk populations pulmonary nodule detection increased. Pulmonary nodules of unknown origin and with a diameter > 5 mm carry a significant risk of malignancy implying that invasive intervention to obtain tissue proof is needed. Traditional resection method is open thoracotomy, but with the advent of the minimal invasive video assisted thoracoscopic surgery (VATS) open thoracotomy is no longer required. However localisation of pulmonary nodules can be problematic. Therefore various localisation methods have been developed and introduced. One of these localisation methods is CT-guided percutaneous hookwire localisation. Materials and methods: Between April 2006 and June 2015 we performed CT-guided percutaneous hookwire localisation prior to VATS wedge resection on the same day. The efficacy of CT-guided percutaneous hookwire localisation was evaluated in terms of CT-localisation and VATS times, CT-localisation and VATS success rate, complication rate and conversion to open thoracotomy rate. Results: We performed 150 localisations in 147 patients. All pulmonary nodules were successfully located and resected. Nodule diameters were <25 mm (median 9, range 4 – 24) and were located within 30 mm of the pleural surface (median 7, range 0 – 29). Median CT-procedure time was 25 min (range 5 – 72 min), median VATS time was 49 min (range 14 – 169 min). There was a radical resection rate of 96% and in 100% a definitive histological diagnosis was stated. Complications requiring intervention during CT-procedure occurred in 8%, mainly a pneumothorax requiring a pleuracath. Complications of VATS consisted of 12 (8,0%) minor complications and 3 (2,0%) major complications. There was a conversion to open thoracotomy in 7,4% of our cases. Re-operation was required in 3 (2,0%) patients and the median length of hospital stay was 4,5 days (range 2 – 52). The 30 day mortality was 1,3% and in hospital mortality 0,7%. Pathology analysis revealed 32 primary lung cancers, 84 metastases and 34 benign lesions. Conclusion: Pre-operative CT-guided percutaneous hookwire localisation is safe and reliable additional to VATS for pulmonary nodule resection. It minimizes removal of healthy lung tissue and allows 100% diagnostic accuracy of VATS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Wekken, Drs. A.J. van der |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2115 |
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