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 Conclusions Laser use significantly reduced tissue loss, postoperative air leakage, and hospital stay. Influence on long-term survival was not statistically proven.