Video-Assisted Thoracoscopic Pleural Adhesiotomy and Decortication for Complicated Pleural Space Occupying Lesions / 대한흉부외과학회지

ABSTRACT

BACKGROUND: Complicated pleural space occupying lesions (SOL) have been treated by thoracentesis, closed thoracotomy drainage (CTD) or surgical intervention with using a video thoracosocpe or open thoracotomy depending on the extent of the disease. With the development of video assisted thoracoscopic surgery (VATS), VATS pleural adhesiolysis and decortication have revealed good results as compared to those for open thorcotomy. To assess the effectiveness of VATS pleural adhesiolysis and decortication, we retrospectively analyzed the medical record and radiologic findings of the patients with complicated pleural SOL and who were treated by this surgery. MATERIAL AND METHOD: From May 1996 to April 2006, 64 patients (mean age 41.8 years) with complicated pleural SOL underwent 65 VATS. To analyze the surgical outcome, we classified the postoperative findings on the simple chest X-rays into 4 classes as Class I no or minimal pleural lesion, Class II blunting of the cardiophrenic angle and mild pleural thickening, Class III an elevated diaphgram or persistent lung collapse and Class IV complicated or recurrent effusion. RESULT: Before VATS, the patients underwent the diagnostic or therapeutic procedures single or repeat diagnostic tapping for 41, thoracoscotomy drainage for 11, pigtail catheter drainage for 10 and intrapleural fibrinolytics for 10. The mean duration between the onset of symptom and surgery was 18.4 days. There was neither mortality nor severe complications. The surgical outcomes were class 1 for 28, class 2 for 13, class 3 for 19 and class 4 for 5. There were statistically significant differences between the symptom duration and the classes, and between the operation time and the classes. CONCLUSION: VATS pleural adhesiolysis and decortication are effective, safe treatments for managing complicated pleural SOL, and an earlier operation is needed for obtaining a better surgical outcome.