The Role Of Video-assisted Thoracoscopic Surgery In Management Of The Multiple Ground-glass Nodules

Objective:We investigated the pathological type, features of lymph nodes metastasis and prognosis of multiple ground-glass nodules (GGNs), in an attempt to identify the role of video-assisted thoracoscopic surgery (VATS) in diagnosis and treatment.Methods:From March 2013 to May 2015, the data of 21 patients(7 males and 14 females; mean age 52 years) who underwent VATS resections for multiple pulmonary GGNs at Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University were collected. We analyzed the CT features, locations, surgery methods and histological results of GGNs, and try to figure out the role of VATS in diagnosis and treatment for such lesions.Results:The surgeries were performed successfully in all patients without serious postoperative complication. Fifty-one GGNs were detected in 21 patients through CT screening. The number of patients with nodules localized in the same lobe was 2, that in different lobes of ipsilateral thorax was 7 and the bilateral was 12. The number of nodules with which were<10mm,10-20mm,20-30mm and> 30mm were 10,36,15 and 5, respectively. There were 40 pure GGNs and 11 part-solid ones.46 of the 51 lesions were resected via VATS. Transthoracic VATS via a single-port or two-ports were performed on 18 patients, and VATS via a subxiphoid single-port were accomplished on 3. Four pure GGNs<10 mm and deep in the lung were proceeded with continuous follow-up. One pure GGN measuring 16 mm considered as part-solid nodule and also deep in the lung underwent stereotactic ablative radiotherapy. Of the 46 resected lesions,4 (8.7%) were atypical adenomatous hyperplasia (AAH),23 (50%) were adenocarcinoma in situ (AIS),15 (32.7%) were minimally invasive adenocarcinoma (MIA),2 (4.3%) were invasive adenocarcinoma, one was pulmonary sclerosing hemangioma, and one was nonspecific fibrosis. Intersegmental lymph node metastasis was found in one of the 21 patients, and the rest resected lymph nodes were proved to be negative. The hospital stays were 9 days. No recurrence and new nodules were found in the CT scan in 3 months. All of the 21 patients were tested with satisfactory pulmonary function.Conclusions:(1) VATS is feasible and safe in management of multiple GGNs, and provides diagnosis and treatment at the same time. (2) The histological results are mainly AAH, AIS, MIA, with rare positive lymph nodes and metastasis. (3)Multiple GGNs were generally independent primary lung cancers with favorable prognosis rather than intrapulmonary metastasis. This is the same to patients with malignancy history, and further methods should be taken to make true diagnosis with the aim to avoid excessive chemotherapy.