F-046
A COMPARATIVE ANALYSIS OF PANCOAST TUMOURS RESECTION PERFORMED VIA VIDEO-ASSISTED THORACIC SURGERY VERSUS STANDARD OPEN APPROACHES

The use of video-assisted thoracic surgery (VATS) in the management of Pancoast tumours has been recently proposed in order to minimize chest wall trauma. The aim of this study is to understand if the less invasive approach is advantageous compared to the standard technique in the treatment of Pancoast tumours.

In the last 8 years, 34 patients with Pancoast tumours underwent surgery as part of multimodaility treatment. In 16 cases a standard approach was attended while in 22 cases the resection was performed using the VATS approach. In all cases, an en-bloc chest wall resection and mediastinal lymphadenectomy were performed. Preoperative, operative and postoperative data were recorded in all patients. In addition, postoperative pain measured with the VAS scale, arm shoulder function using motion test and action research arm test and quality of life using the disability of the arm and shoulder questionnaire (DASH test) were also recorded for each patients. The two groups were statistically compared.

In 4 patients of the VATS group, the resection was contraindicated for the presence of pleural carcinosis not detected on the preoperative diagnostic work-up. No significant difference was found between the standard group and VATS group regarding morbidity and mortality. VATS versus standard group presented a reduction of postoperative pain (P < 0.001, ANOVA test), a better result of motion test (14.8 ± 5.87 vs 10.5 ± 7.56; P = 0.01, Mann-Whitney test), of action research arm test (54.25 ± 4.56 vs 47 ± 9.7, P = 0.02, Mann-Whitney test), and of DASH test (35.5 ± 7.3 vs 40.3 ± 6, P = 0.02, Mann-Whitney test).

VATS may be an effective and safe adjunct to standard surgical resection in patients with Pancoast tumours. It reduces postoperative pain, preserves latissimus dorsi muscle and allows to detect pleural carcinosis avoiding exploratory thoracotomy.

All authors have declared no conflicts of interest.