Partial Lung Resection by Nd-YAG or Diode Lasers for Pulmonary Metastases

Objective:Though the use of staplers for partial lung resection in cases of pulmonary metastases is popular, a high incidence of local recurrence in such cases has been pointed out. We therefore applied a laser device instead of a stapler to resect the lesion and evaluated the rate of local recurrence between these two kinds of apparatus. Patients and Methods: Since July 1995, we performed partial resection of the lung in 33 patients with pulmonary metastases. In 23 of those patients we employed an Nd-YAG or diode laser. First we incised the pleura and lung parenchyma using the Nd-YAG or diode laser in contact mode with an output of 25W. The incision line must be kept at least 10 milimeters apart from the margin of the tumor in all directions. Then in addition we performed the laser irradiation in noncontact mode with an output of 50W in order to prevent postoperative hemostasis and air leakage. The incised pleura was not sutured and the excavated lesion was left open. Results and Comment: 23 patients (37 pulmonary lesions) underwent the laser procedure. No local recurrence has been detected in these patients for intervals of one to 46 months (mean, 21 months). The reason is probably that we can ensure an adequate surgical margin, especially at the bottom of the tumor and also examine the cut surface pathologically. We can eliminate residual malignant cells by thermal effects. On the other hand, 4 of 10 patients who underwent the stapler method showed recurrence at the suture line. Conclusion: Compared with the ordinary stapler method, the laser method is superior from the viewpoint of preventing local recurrence.