Thoracotomic approach for pulmonary metastases

We have read with great interest the article by Gossot et al. reporting the totally thoracoscopic approach for pulmonary anatomic segmentectomies [1]. Concerning the inclusion criteria in the planning treatment for single pulmonary metastasis reported by the authors themselves in nine cases, we have a point for interactive discussion. Despite high resolution computed tomography scan and positron emission tomography-computed tomography remain the preferred imaging modalities for pulmonary metastases, the sensitivity of the technique is 100% for lesions larger than 1 cm, but it decreases according to the size of the metastases (<5 mm). Indeed, as we have yet demonstrated, there is a real problem of missing small metastatic lesions in the video-assisted thoracic surgery approach [2]; moreover, the necessity of a second or third re-resection for recurrent metastases was reported [3]. In conclusion complete manual exploration by axillary-thoracotomy remains the procedure of choice for patients undergoing pulmonary metastasectomy, because of limitation in preoperative radiological assessment of lung lesions smaller than 5 mm.

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