Flexible Videopericardioscopy in cT4 Nonsmall-Cell Lung Cancer With Radiologic Evidence of Proximal Vascular Invasion

Background The purpose of this study was to evaluate feasibility and effectiveness of flexible videopericardioscopy (FVP) in assessing resectability of cT4 nonsmall-cell lung cancer (NSCLC) with radiologic evidence of proximal vascular invasion. Methods Between March 2003 and December 2005, 22 patients with NSCLC deemed unresectable owing to signs of proximal vascular invasion at multislice computed tomography were included in a nonrandomized prospective study entailing FVP performed before curative-intent thoracotomy. Primary outocome measures were technical feasibility (graded from 1 = poor to 3 = excellent) and quality of anatomic visualization (graded as diagnostic or nondiagnostic). Patients with FVP evidence of proximal vascular invasion did not receive thoracotomy and were included in an induction chemoradiotherapy protocol. Results Mean operative time was 31 ± 6 minutes. Technical feasibility ranged from good to excellent in 21 patients. In 1 patient, FVP was not completed owing to intrapericardial adhesions. In 7 patients, FVP disclosed no tumor spread to intrapericardial pulmonary vessels, and radical resection was carried out. The FVP findings were considered not diagnostic because of poor visualization of the right pulmonary artery in 2 patients with bulky hilar tumors. There was no operative mortality and morbidity. Mean hospital stay was 2.9 ± 1 days for patients who did not undergo thoracotomy and 6.3 ± 1 days for patients receiving FVP plus resection. Definitive pathologic staging in patients undergoing resection was pT3N1 (n = 2), pT3N0 (n = 2), pT2N0 (n = 3), and pT2N1 (n = 1). Conclusions Flexible videopericardioscopy proved safely feasible and allowed a better assessment of centrally located NSCLC, with radiologic evidence of proximal vascular involvement eventually resulting in increased resectability rate.