ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Effectiveness of intraoperative bimanual palpation in metastatic tumors of lung
Bülent Mustafa Yenigün1, Cabir Yüksel1, Yusuf Kahya1, Fulden Görgüner1, Ayşe Çoruh Gürsoy2, Gökhan Kocaman1, Murat Özkan1, Serkan Enon1, Ayten Kayı Cangır1
1Department of Thoracic Surgery, Ankara University School of Medicine, Ankara, Turkey
2Department of Radyology, Ankara University School of Medicine, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2020.20429
Background: In this study, we aimed to compare effectiveness of thoracic computed tomography versus intraoperative bimanual palpation in the detection of number of nodules in patients undergoing thoracotomy.

Methods: Between January 2011 and January 2019, a total of 157 patients (63 males, 94 females; mean age: 46.6±11.2 years; range, 13 to 77 years) who underwent pulmonary metastasectomy in our institution were retrospectively analyzed. Metastatic nodules evaluated using thoracic computed tomography were compared with nodules detected by intraoperative palpation.

Results: A total of 226 muscle-sparing thoracotomy was performed in 157 patients. The time between the preoperative thoracic computed tomography and operation ranged from 3 to 24 days. Metastasectomy with muscle-sparing thoracotomy was performed in 41 (26%) patients two times, in eight (5%) patients three times, and in four (2.5%) patients four times due to bilateral lung metastasis or re-metastasectomy. The thoracic computed tomography could detect 476 metastatic nodules, while 1,218 nodules were palpated and resected intraoperatively. Of these nodules, 920 were pathologically evaluated as metastatic.

Conclusion: Our study results showed that the number of nodules reported as pathologically malignant after resection was 1.9 times higher than those reported by thoracic computed tomography. This finding indicates that intraoperative bimanual examination significantly increases the possibility of complete resection. This situation raises the need for more caution for the thoracoscopic metastasectomy procedure in which there is no possibility of intraoperative bimanual palpation.

Keywords : Computed tomography, intraoperative bimanual palpation, metastasis, thoracic surgery
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