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Masahiko Higashiyama, MD; Ken Kodama, MD; Koji Takami, MD; Naozumi Higaki, MD; Hideoki Yokouchi, MD; Tomio Nakayama, MD; Kohei Murata, MD; Masao Kameyama, MD; Jun-ichi Ashimura, CT; Yasuyoshi Naruse, CT; Sachiko Nagumo, CT

Arch Surg. 2002;137:469-474.

Hypothesis  Cytologic analysis of intraoperative lavage at the surgical margin during wedge or segmental resection for pulmonary metastatic lesions predicts postoperative local failure at the surgical margin of the pulmonary parenchyma.

Design  Prospective nonrandomized trial.

Settings  Institution-based study.

Patients  Fifty-one consecutive patients undergoing wedge or segmental resection for 87 pulmonary metastatic lesions of various primary tumor types from November 1, 1997, through January 31, 2001, were prospectively enrolled.

Interventions  An intraoperative lavage cytologic technique at the surgical margin for each pulmonary metastasis was performed as described previously.

Main Outcome Measures  Incidence of positive cytologic findings and postoperative local recurrence at the surgical margin.

Results  Of the examined lesions, 10 (11%) showed positive cytologic results at the surgical margin, despite a macroscopically safe margin in the attempted resection. Of these, metastasectomy was converted to segmentectomy in 3. An additional wedge resection and evaporation using an Nd:YAG laser in the surgical margin were performed in 1 and 4 lesions, respectively. Complications precluded further treatment in 2 lesions. By July 2001, although no local recurrence at the surgical margin area was found among the lesions with negative cytologic results, recurrence at the surgical margin occurred in 2 with positive cytologic results, including 1 receiving no treatment and 1 receiving Nd:YAG laser evaporation, indicating that a significant difference in the recurrence rate according to lavage cytologic status (P<.001).

Conclusions  This intraoperative lavage cytologic technique in wedge or segmental resection of pulmonary metastases of various primary tumors may be a useful predictor of local recurrence at the surgical margin. With these test results, local recurrence at the surgical margin may be controllable in patients undergoing pulmonary metastasectomy.

From the Departments of Thoracic Surgery (Drs Higashiyama, Kodama, Takami, Higaki, and Yokouchi), Respiratory Medicine (Dr Nakayama), Surgery (Drs Murata and Kameyama), and Cytology (Messrs Ashimura and Naruse and Ms Nagumo), Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.

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