The value of the Nd:YAG laser for the surgery of lung metastases in a randomized trial

Objective: A prospective randomized trial was established in our department to compare the usefulness of the neodymium:yttrium-aluminum- garnet (Nd:YAG) laser in resection of lung metastases. We report the results of the first 45 patients after a minimum of 2 years of follow-up. Design: Randomized prospective trial from March 1987 to March 1995. Setting: University teaching hospital. Patients: Forty-five patients underwent resection for pulmonary metastases with two different techniques chosen at random: 23 patients were treated with an Nd:YAG laser (group A) and 22 patients with a traditional diathermic device (group B). Interventions: A total of 71 pulmonary lesions were resected by minimal excision, 41 by laser and 30 by diathermy. Sixty-three lesions were diagnosed as active metastases from various sites. Results: No deaths occurred during surgery. Eight patients (6 in group B) developed minor complications. In two patients from group B, lesions recurred at the resection site. The use of Nd:YAG laser was not associated with a significantly longer survival (log rank test, p=0.49). Laser resection allowed more tissue sparing (mean ratio lesion diameter/volume resected, 0.94 vs 1.11, p<0.008). Univariate and multivariate analyses revealed the importance of laser use in reducing the number of days of postoperative air leakage (3.91 vs 5.00 days) and hospital stay (7.50 vs 9.90 days). Conclusions: Laser use significantly reduced tissue loss, postoperative air leakage, and hospital stay. Influence on long-term survival was not statistically proven.