Indications And Methods Of Surgical Treatment Of Solitary Pulmonary Nodule

PURPOSE: The diagnosis and treatment of solitary pulmonary nodule (SPN) is a common but complex clinical problem, for which the investigation of the role of thoracic surgery comprised the purpose of the present study. Met hods : By computerized literature search we tried to answer three questions: a) when is surgical resection (diagnostic or therapeutic) of SPN is indicated? b) what type of surgical resection is required {lobectomy or limited (sublobar) lung resection such as wedge resection or anatomic segmentectomy} for malignant SPN? and c) by what method (VATS or open thoracotomy) should be performed biopsy-resection of SPN? Results : We noted that the increased probability for malignancy of a SPN as reflected by the existing imaging methods and the failure to set histological diagnosis with modern invasive but non-surgical methods are the main indications for thoracic surgical intervention (diagnostic or therapeutic). About whether lobectomy or sublobar resection is the best surgical treatment approach, we found that although they have comparable survival rates, wedge resection is associated with fewer complications, shorter hospitalization but higher percentages of local recurrences in contrast to anatomic segmentectomy which has similar results to those of lobectomy. As to whether video-assisted thoracic surgery or open thoracotomy is the best diagnostic or therapeutic surgical approach for a SPN, they exhibit comparable results, both diagnostically and therapeutically. Conclusions : More randomized controlled trials are needed for comparing video-assisted thoracic surgery with open thoracotomy and the various types of surgical resection of SPN.