Is VATS lobectomy standard of care for operable non-small cell lung cancer?
Video-Assisted Thoracic Surgery (VATS) for treatment of lung cancer is being increasingly applied worldwide in the last few years. Since its introduction, many publications have been providing strong evidences that this minimally invasive approach is feasible, safe and oncologically efficient; offering to patients several advantages over traditional open thoracotomy, particularly for early-stage disease (I and II). The application of VATS for locally advanced disease treatment has also been largely described, but probably requires a further level of experience, which is more likely to be found in reference centers, with skilled experts. Although a large multi-institutional prospective randomized-controlled trial is the best way to confirm the superiority of one technique over another, such study comparing VATS versus open lobectomy for lung cancer is unlikely to ever come out. And in this scenario, retrospective data remains as the most reliable source of scientific information. Based on a literature review, the main objective of this article is to discuss to what extent VATS lobectomy can be considered the gold standard in the surgical treatment of lung cancer, taking into account the most important comparison aspects between the minimally invasive approach and open thoracotomy technique. This review addresses questions regarding lymph node dissection, oncologic efficacy, extended resections beyond standard lobectomy, post-operative complications/pain/quality of life, survival rates and the present limits of indication (and contraindication) for VATS, in order to define the real role of this technique on the surgical treatment of lung cancer in a minimally invasive, but safe and effective manner.
Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brazil; Department of Thoracic Surgery, Hospital Central da Polícia Militar (HCPM), Rio de Janeiro, Brazil. Electronic address: fvannucci@me.com.
Fernando
F
Vannucci
Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: diego.gonzalez.rivas@sergas.es.
Diego
D
Gonzalez-Rivas
D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000592:standards*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012189:Retrospective Studies; D059039:Standard of Care; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods
Anatomic lung resection; Lung cancer; Minimally invasive thoracic surgery; VATS lobectomy; Video-assisted thoracic surgery