Cabir YÜKSEL, Gökhan KOCAMAN, Bülent Mustafa YENİGÜN, Serkan ENON, Ayşe ÇORUH GÜRSOY, Yusuf KAHYA, Fulden GÖRGÜNER, Murat ÖZKAN, Ayten KAYI CANGIR

Akciğerin metastatik tümörlerinde intraoperatif bimanuel palpasyonun etkinliği

Amaç: Bu çalışmada torakotomi yapılan hastalarda nodül sayısının tespit edilmesinde toraks bilgisayarlı tomografi ile intraoperatif bimanuel palpasyonun etkinliği karşılaştırıldı.Ç a l ı ş m a p l a n ı :Ocak 2011 - Ocak 2019 tarihleri arasında hastamizde akciğer metastazektomisi uygulanan toplam 157 hasta (63 erkek, 94 kadın; ort. yaş: 46.6±11.2 yıl; dağılım, 13-77 yıl) retrospektif olarak incelendi. Toraks bilgisayarlı tomografi ile değerlendirilen metastatik nodüller, intraoperatif palpasyon ile tespit edilen nodüller ile karşılaştırıldı.Bul gu lar: Toplam 157 hastaya 226 kas koruyucu torakotomi yapıldı. Ameliyat öncesi toraks bilgisayarlı tomografi ve ameliyat arasında geçen zaman 3 ila 24 gün idi. Bilateral akciğer metastazı veya yeniden metastazektomi nedeniyle 41 hastaya (%26) iki kez, sekiz hastaya (%5) üç kez ve dört hastaya (%2.5) dört kez kas koruyucu torakotomi ile metastazektomi uygulandı. Toraks bilgisayarlı tomografi ile 476 metastatik nodül tespit edilirken, intraoperatif olarak 1218 nodül palpe edilip rezeke edildi. Bu nodüllerin 920’si patolojik açıdan malign olarak değerlendirildi.S o n u ç :Çalışma sonuçlarımız rezeksiyon sonrasında patolojik açıdan malign olarak bildirilen nodül sayısının, toraks bilgisayarlı tomografiye kıyasla, 1.9 kat daha fazla olduğunu gösterdi. Bu bulgu, intraoperatif bimanuel muayenenin, tam rezeksiyon olasılığını anlamlı düzeyde artırmakta olduğunu göstermektedir. Bu durum, intraoperatif bimanuel palpasyon olasılığının olmadığı torakoskopik metastazektomi ameliyatında daha dikkatli olunması gerekliliğini ortaya koymaktadır.A n a h t a r s ö z c ü k l e r :Bilgisayarlı tomografi, intraoperatif bimanuel palpasyon, metastaz, göğüs cerrahisi.

Effectiveness of intraoperative bimanual palpation in metastatic tumors of lung

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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