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Updates on Minimally Invasive Surgery in Non-Small Cell Lung Cancer

Current Treatment Options in Oncology volume 20, Article number: 16 (2019) Cite this article

Opinion statement

Video-assisted thoracic surgery (VATS) has become widely used since the 1990s and has become a standard treatment approach mainly for early-stage non-small cell lung cancer. The few randomized controlled trials providing evidence of the effectiveness of VATS lobectomy at present are supported by a large number of propensity-matched studies, several high-quality meta-analyses, and outcome studies. These studies provide comprehensive data demonstrating the lower morbidity, shorter chest tube duration, and shorter hospital stay of VATS than thoracotomy during the postoperative course. Moreover, VATS shows equivalent oncological outcome as thoracotomy and therefore should be performed for lobectomy as much as possible. Importantly, VATS has recently been applied to advanced cases and previously contraindicated complex procedures such as bronchoplasty and chest wall resection. Attention has also been paid to reduced port surgery performed by frontier surgeons. Thus, the indications of VATS have seen a significant expansion. This major development logically negates any hesitation to change to the VATS technique as any doubt will likely constrain its wider applications. Preparation of scientific learning environments is necessary and should be actively pursued to adopt new skills instead of debating between the choice of “VATS or open.”

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  1. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Endo S, Natsugoe S, Shimizu H, Doki Y, et al. Thoracic and cardiovascular surgery in Japan during 2015. Gen Thorac Cardiovasc Surg. 2018;66:581–615.

    Article  Google Scholar 

  2. Whitson BA, Groth SS, Duval SJ, et al. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008;86:2008–16.

    Article  Google Scholar 

  3. Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small cell lung cancer. J Clin Oncol. 2009;27:2553–62.

    Article  Google Scholar 

  4. Gopaldas RR, Bakaeen FG, Dao TK, et al. Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients. Ann Thorac Surg. 2010;89:1563–70.

    Article  Google Scholar 

  5. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139:366–78.

    Article  Google Scholar 

  6. D’Amico TA, Niland J, Mamet R, et al. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg. 2011;92:226–31.

    Article  Google Scholar 

  7. Okada M, Sakamoto T, Yuki T, et al. Hybrid surgical approach of video-assisted minithoracotomy for lung cancer: significance of direct visualization on quality of surgery. Chest. 2005;128:2696–701.

    Article  Google Scholar 

  8. Swanson SJ, Herndon JE II, D’Amico TA, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802 a prospective, multi-institution feasibility study. J Clin Oncol. 2007;25:4993–7.

    Article  Google Scholar 

  9. • Nwogu CE, D’Cunha J, Pang H, Gu L, Wang X, Richards WG, et al. VATS lobectomy has better perioperative outcomes than open lobectomy: CALGB 31001, an ancillary analysis of CALGB 140202 (Alliance). Ann Thorac Surg. 2015;99:399–405. One of the representative reports of propensity-matched analysis comparing the short-term postoperative course of VATS and thoracotomy.

    Article  Google Scholar 

  10. Scott WJ, Allen MS, Darling G, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;139:976–81.

    Article  Google Scholar 

  11. Flores RM, Park BJ, Dycoco J, Aronova A, Hirth Y, Rizk NP, et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2009;138:11–8.

    Article  Google Scholar 

  12. •• Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hurtgen M, Petersen RH, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardio-Thorac Surg. 2016;49:602–9. Propensity-matched analysis comparing the postoperative course of lobectomy by VATS and that by thoracotomy using the European Society of Thoracic Surgeon (ESTS) database.

    Article  Google Scholar 

  13. Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70.

    Article  Google Scholar 

  14. Kirby TJ, Mack MJ, Landreau RJ, et al. Lobectomy–video-assisted thoracic surgery versus muscle sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg. 1995;109:997–1002.

    CAS  Article  Google Scholar 

  15. Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg. 2000;24:27–30.

    CAS  Article  Google Scholar 

  16. Su S, Scott WJ, Allen MS, Darling GE, Decker PA, McKenna RJ, et al. Patterns of survival and recurrence after surgical treatment of early stage non-small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial. J Thorac Cardiovasc Surg. 2014;147:747–53.

    Article  Google Scholar 

  17. Berry MF, D’Amico TA, Onaitis MW, Kelsey CR. Thoracoscopic approach to lobectomy for lung cancer does not compromise oncologic efficacy. Ann Thorac Surg. 2014;98:197–202.

    Article  Google Scholar 

  18. Hanna WC, Valence M, Atenafu EG, Cypel M, Waddell TK, Yasufuku K, et al. Is video-assisted lobectomy for non-small cell lung cancer oncologically equivalent to open lobectomy? Eur J Cardio-Thorac Surg. 2013;43:1121–5.

    Article  Google Scholar 

  19. Boffa DJ, Kosinski AS, Paul S, et al. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg. 2012;94:347–53.

    Article  Google Scholar 

  20. Jheon S, Yang HC, Cho S. Video-assisted thoracic surgery for lung cancer. Gen Thorac Cardiovasc Surg. 2012;60:255–60.

    Article  Google Scholar 

  21. Zhong C, Fang W, Mao T, et al. Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer. Ann Thorac Surg. 2012;94:362–7.

    Article  Google Scholar 

  22. Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg. 2012;94:668–81.

    Article  Google Scholar 

  23. Shapiro M, Weiser TS, Wisnivesky JP, et al. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg. 2009;137:1388–93.

    Article  Google Scholar 

  24. Huang J, Li S, Hao Z, Chen H, He J, Xu X, et al. Complete video-assisted thoracoscopic surgery (VATS) bronchial sleeve lobectomy. J Thorac Dis. 2016;8:553–74.

    Article  Google Scholar 

  25. • Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer. 2016;100:114–9 Comprehensive review of postoperative outcome, oncological efficacy, indication, and contraindication of VATS.

    Article  Google Scholar 

  26. Gonzalez-Rivas D, Fieira E, Delgado M, de la Torre M, Mendez L, Fernandez R. Uniportal video-assisted thoracoscopic sleeve lobectomy and other complex resections. J Thorac Dis. 2014;6:S674–81.

    PubMed  PubMed Central  Google Scholar 

  27. Berry MF, Onaitis MW, Tong BC, Balderson SS, Harpole DH, D’Amico TA. Feasibility of hybrid thoracoscopic lobectomy and en-bloc chest wall resection. Eur J Cardio-Thorac Surg. 2012;41:888–92.

    Article  Google Scholar 

  28. Yang HX, Woo KM, Sima CS, Bains MS, Adusumilli PS, Huang J, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage I non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg. 2017;265:431–7.

    Article  Google Scholar 

  29. Oh DS, Reddy RM, Gorrepati ML, Mehendale S, Reed MF. Robotic-assisted, video-assisted thoracoscopic and open lobectomy: propensity-matched analysis of recent premier data. Ann Thorac Surg. 2017;104:1733–40.

    Article  Google Scholar 

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Acknowledgements

We thank Dr. Edward Barroga (http://orcid.org/0000-0002-8920-2607), a professional medical editor and an Associate Professor of the Department of Medical Education of Tokyo Medical University, for reviewing and editing the manuscript.

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  1. Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan

    Norihiko Ikeda MD, PhD

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Correspondence to Norihiko Ikeda MD, PhD.

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Conflict of Interest

Norihiko Ikeda has received research funding from AstraZeneca, Pfizer, Merck Sharpe & Dohme, Eli Lilly Japan, Chugai Pharmaceutical Co., Ltd., Taiho Pharmaceutical, Boehringer Ingelheim, and Ono Pharmaceutical Co., Ltd.

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Ikeda, N. Updates on Minimally Invasive Surgery in Non-Small Cell Lung Cancer. Curr. Treat. Options in Oncol. 20, 16 (2019). https://doi.org/10.1007/s11864-019-0614-9

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  • DOI: https://doi.org/10.1007/s11864-019-0614-9

Keywords

  • Lung cancer
  • Minimally invasive surgery
  • Video-assisted thoracic surgery (VATS)