HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eugenio Pompeo Tommaso Claudio Mineo Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pompeo, E. Articles by Mineo, T. C. Search for Related Content PubMed PubMed Citation Articles by Pompeo, E. Articles by Mineo, T. C. Related Collections Minimally invasive surgery

J Thorac Cardiovasc Surg 2007;133:960-966
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Awake pulmonary metastasectomy

Thoracic Surgery Division, Tor Vergata University School of Medicine, Policlinico Tor Vergata, Rome, Italy.

Received for publication May 23, 2006; revisions received August 29, 2006; accepted for publication September 20, 2006.

^_* Address for reprints: Eugenio Pompeo, MD, Cattedra di Chirurgia Toracica, Università Tor Vergata, Policlinico Tor Vergata, V.le Oxford, 81, 00133 Rome, Italy. (Email: pompeo{at}med.uniroma2.it).

Objective: General anesthesia with single-lung ventilation and bimanual lung palpation is considered mandatory in pulmonary metastasectomy. We assessed the safety, feasibility, and early results of awake pulmonary metastasectomy under sole thoracic epidural anesthesia.

Methods: Between December 2003 and December 2005, 14 patients with radiologic evidence of peripheral solitary lung metastases underwent awake thoracoscopic metastasectomy under sole thoracic epidural anesthesia at T4 to T5. To achieve bimanual-like full lung palpation, a modified digital-instrumental palpation method was used. Anesthesia time, operative time, global operating room time, patient satisfaction with the anesthesia, and technical feasibility scored into 4 grades (from 1 = poor to 4 = excellent) were assessed. Preoperative and postoperative data were compared with those of a historical cohort undergoing video-assisted transxiphoid lung metastasectomy through general anesthesia and 1-lung ventilation.

Results: There was neither mortality nor major morbidity. Technical feasibility was excellent in 10 instances and good or satisfactory in 2 instances, whereas anesthesia satisfaction score was excellent to good in 12 patients. Of 18 resected nodules, 15 proved to be metastases. At awake and control group comparisons, significant differences included median operative time (25.5 minutes vs 48.5 minutes, P < .00001), global in-operating room time (62.5 minutes vs 147.5 minutes, P < .00001), and hospital stay (2.5 days vs 4.0 days, P = .02). There was no difference in lung recurrence (2 vs 3, P = .66) 3-year actuarial survivals (40% vs 78%, P = .29).

Conclusions: Awake pulmonary metastasectomy proved safe and feasible. Global operating room time and hospital stay were significantly shorter than those of the control group who underwent operation with general anesthesia, whereas oncologic results were comparable.

This article has been cited by other articles:

				F. Dexter, E. U. Dexter, D. Masursky, and N. A. Nussmeier Systematic Review of General Thoracic Surgery Articles to Identify Predictors of Operating Room Case Durations Anesth. Analg., April 1, 2008; 106(4): 1232 - 1241. [Abstract] [Full Text] [PDF]

				T. C. Mineo Epidural anesthesia in awake thoracic surgery Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 13 - 19. [Abstract] [Full Text] [PDF]