Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Non-Small Cell Lung Cancer Greater Than 5 cm: Is VATS a feasible approach for large tumors?

Abstract

Background VATS lobectomy is a recommended surgical approach for patients with early-stage lung cancer. However, it is still controversial in locally advance disease. This study was conducted to compare intraoperative and postoperative results of VATS and thoracotomy in patients with tumors greater than 5 cm. Methods From January 2014 to December 2018, 849 patients underwent lobectomy or pneumonectomy for the treatment of non-small-cell lung cancer at our center. The inclusion criterion of this study was patients who underwent anatomic lung resection for lung cancer with tumors larger than 5 cm((≥ T3). The patients were divided into two groups: those who underwent video-assisted thoracoscopic surgery (n = 24) and those who underwent thoracotomy (n = 36). Patient characteristics, intraoperative and postoperative results were evaluated by review of the hospital records. Results In the VATS group, mean drainage time and postoperative length of hospital stay were significantly shorter than the thoracotomy group. Kaplan–Meier survival curves showed that overall and recurrence-free survival was longer in the VATS group and this result was statistically significant. Conclusions According to the results of this study, we emphasize that VATS is a feasible surgical procedure for tumors larger than 5 cm.

Perioperative Inflammatory Response and Cancer Recurrence in Lung Cancer Surgery: A Narrative Review

“…A retrospective study of stage IA NSCLC patients who underwent lobectomy demonstrated that VATS was associated with increased 5-year OS compared to open thoracotomy (100% vs. 87%, p = 0.01) and DFS (100% vs. 86%, p = 0.03) ( 63 ). In tumors greater than 5 cm, VATS was associated with greater OS and DFS ( p = 0.056 and 0.031, respectively) compared to open thoracotomy ( 64 ), and in clinical N2 lung cancer, VATS showed similar 5-year OS (50.5% vs. 48.4%, p = 0.127) and DFS (60.5% vs. 44.6%, p = 0.069) ( 65 ). A study of oncological outcomes in patients who underwent surgical resection for early-stage lung cancer found no differences in 5-year OS (71.6% vs. 65.9%, p = 0.36) and DFS (75.2% vs. 69.2%, p = 0.55) between VATS and open lobectomy ( 66 ).…”

Immunological perspectives in thoracic surgery: a narrative review on the cellular and cytokine responses induced by thoracotomy and video-assisted thoracic surgery

“…Non-intubated thoracic surgical procedures are widely used to perform minor and major thoracic surgeries, and is a feasible technique to perform pleural and lung biopsies, metastasectomies, anatomical lung resections and surgeries to pneumothorax (66,67). The main principle is to create iatrogenic pneumothorax, thus, the operator has enough space to implement the surgery and to avoid the use of double-lumen endotracheal tube.…”

The Role of Minimally Invasive Surgery in the Treatment of Lung Cancer

“…In a study, we conducted in our clinic, which included 60 patients with tumors larger than 5 cm, mean drainage time and postoperative length of hospital stay were significantly shorter [50] (Figure 6).…”

“…Moreover, many studies have demonstrated that VATS can be applied with low complication rates after neoadjuvant therapy or in cases with large tumors [49][50][51][52].…”