Futile lobectomies following video-thoracoscopic exploration for indeterminate pulmonary nodules: a retrospective study

Background: Lung cancer screening is correlated with an increase in detection of small indeterminate pulmonary nodules and these nodules often require operative resection to obtain the diagnosis. In suspected early-stage lung cancer, video-assisted thoracoscopic surgery (VATS) has become the preferred option. In this context of minimally invasive surgery, diagnostic wedge resection is sometimes difficult to perform for small deep impalpable nodules. So, our purpose was to determine whether performing VATS for indeterminate pulmonary nodule increases the risk of lobectomy for benign lesions. Methods: A retrospective analysis was carried out in our center from January 2013 to January 2019 on patients who underwent resection for a solitary pulmonary nodule suspicious for cancer. Resection method, frozen section analysis, post-operative outcomes, operative and pathology reports were reviewed. Results: Six hundred fifty-one patients underwent surgical exploration for a solitary pulmonary nodule. 345 patients underwent VATS and 306 patients underwent thoracotomy. Patients in the VATS group underwent significantly more wedge resections (P=0.012) and diagnosis of lung cancer was significantly more frequent in the thoracotomy group (P<0.001). 132 patients (38.3%) in the VATS group and 60 patients (19.6%) in the thoracotomy group underwent lobectomy without frozen section analysis of the pulmonary nodule. There was no significant difference in terms of lobectomy performed for a benign lesion between the two groups. Conclusions: Video-assisted thoracoscopic surgery was associated with a higher rate of benign lesion resection but was not associated with a higher rate of lobectomies for benign lesion in our study.

Automated summary

The purpose of this study was to evaluate whether performing video-assisted thoracoscopic surgery (VATS) for indeterminate pulmonary nodules increases the risk of lobectomy for benign lesions. The results showed that patients in the VATS group underwent more wedge resections, while the thoracotomy group had a significantly higher frequency of lung cancer diagnosis. The rate of lobectomy was higher in the VATS group, but there was no significant difference in terms of lobectomy performed for a benign lesion between the two groups.