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Does video-assisted thoracoscopic lobectomy produce equal cancer clearance compared to open lobectomy for non-small cell carcinoma of the lung?

^a Department of Thoracic Surgery, Hairmyres Hospital, East Kilbride, Scotland
^b Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Department of Thoracic Surgery, Hairmyres Hospital, Eaglesham Road, East Kilbride, G75 8RG, UK.

E-mail address: dgwest{at}rcsed.ac.uk (D. West).

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether a VATS lobectomy produces an equivalent cancer clearance compared to an open technique. Using the reported search 409 papers were identified. Twenty-one papers represented the best evidence on the subject from which 15 are fully tabulated. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. We conclude that repeated cohort studies have shown 5-year survival rates similar in the VATS groups to that achieved from open thoracotomy. The majority of resections are in Stage I tumours <3–5 cm in size and five-year survival rates of 70% or better have consistently been reported. It is reasonable to assume that this cancer cure is similar to open resection although it must be remembered that significant selection bias occurs in all these non-randomized studies. A few case reports have raised concerns about port site recurrence and seeding with VATS but the incidence of incision recurrence in open procedures is also unknown. Finally, there is little data to support improved hospital stay, reduced costs or improved patient experience with VATS, and thus, while equivalence has been well shown with the open technique, further randomized studies are required to demonstrate superiority.

Key Words: Video-assisted thoracoscopic surgery; Lobectomy; Non-small cell carcinoma of the lung