Lung Resection

Reference work entry


Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related mortality worldwide. Despite recent advances in molecular characterization and systemic therapies, surgical resection remains the mainstay of curative treatment. Anatomic lobectomy is the reference standard surgical approach to localized disease. Sublobar resections (wedge, segmentectomy) may be acceptable in patients who have marginal cardiopulmonary reserve or in those with exceptionally small tumors. Minimally invasive video-assisted thoracic surgery (VATS) techniques, in particular VATS lobectomy, are being increasingly utilized and championed over traditional thoracotomy approaches in the treatment of localized NSCLC for the reported benefits of lower operative morbidity, accelerated postoperative recovery, and oncologic equivalence. This chapter will review the various operative approaches with a focus on the benefits of minimally invasive techniques.


Minimally Invasive Surgical Early Stage NSCLC Sublobar Resection Thoracotomy Group Lung Cancer Study Group 
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  1. 1.
    Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun M. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.CrossRefPubMedGoogle Scholar
  2. 2.
    Gridelli C, Perrone F, Monfardini S. Lung cancer in the elderly. Eur J Cancer. 1997;33:2313–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Gridelli C. Chemotherapy of non-small cell lung cancer in the elderly. Lung Cancer. 2002;38(suppl 3):S67–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Yancik R, Ries LA. Aging and cancer in America. Demographic and epidemiologic perspectives. Hematol Oncol Clin North Am. 2000;14:17–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Ginsberg RJ, Hill LD, Eagan RT, Thomas P, Mountain CF, Deslauriers J, et al. Modern thirty-day operative mortality for surgical resections in lung cancer. J Thorac Cardiovasc Surg. 1983;86:654–8.PubMedGoogle Scholar
  6. 6.
    Damhuis RA, Schutte PR. Resection rates and postoperative mortality in 7899 patients with lung cancer. Eur Respir J. 1996;9:7–10.CrossRefPubMedGoogle Scholar
  7. 7.
    Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons general thoracic surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008;135:247–54.CrossRefPubMedGoogle Scholar
  8. 8.
    Kirby TJ, Rice TW. Thoracoscopic lobectomy. Ann Thorac Surg. 1993;56:784–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Walker WS, Carnochan FM, Pugh GC. Thoracoscopic pulmonary lobectomy. J Thorac Cardiovasc Surg. 1993;106:1111–7.PubMedGoogle Scholar
  10. 10.
    McKenna RJ. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg. 1994;107:879–82.PubMedGoogle Scholar
  11. 11.
    Lewis RJ. Simultaneously stapled lobectomy: a safe technique for video-assisted thoracic surgery. J Thorac Cardiovasc Surg. 1995;109:619–25.CrossRefPubMedGoogle Scholar
  12. 12.
    Swanson SJ, Herndon JE, D’Amico TA, Demmy TL, McKenna RJ, Green MR, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802-a prospective, multi-institutional feasibility trial. J Clin Oncol. 2007;25:4993–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Park BJ, Flores RM, Rusch VW. Robotic assistance for video-assisted thoracic surgical lobectomy: technique and initial results. J Thorac Cardiovasc Surg. 2006;131:54–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Magistrelli P, D’Ambra L, Berti S, et al. Use of India ink during preoperative computed tomography localization of small peripheral undiagnosed pulmonary nodules for thoracoscopic resection. World J Surg. 2009;33:1421–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Choi BG, Kim HH, Kim BS, et al. Pulmonary nodules: CT-guided contrast material localization for thoracoscopic resection. Radiology. 1998;208:399–401.CrossRefPubMedGoogle Scholar
  16. 16.
    Chella A, Lucchi M, Ambrogi MC, et al. A pilot study of the role of TC-99 radionuclide in localization of pulmonary nodular lesions for thoracoscopic resection. Eur J Cardiothorac Surg. 2000;18:17–21.CrossRefPubMedGoogle Scholar
  17. 17.
    Pittet O, Christodoulou M, Pezzetta E, et al. Video-assisted thoracoscopic resection of a small pulmonary nodule after computed tomography-guided localization with a hook-wire system. Experience in 45 consecutive patients. World J Surg. 2007;31:75708.CrossRefGoogle Scholar
  18. 18.
    Chen YR, Yeow KM, Lee JY, et al. CT-guided hook wire localization of subpleural lung lesions for video-assisted thoracoscopic surgery (VATS). J Formos Med Assoc. 2007;106:911–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Nakashima S, Watanabe A, Obama T, et al. Need for preoperative computed tomography-guided localization in video-assisted thoracoscopic surgery pulmonary resections of metastatic pulmonary nodules. Ann Thorac Surg. 2010;89:212–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Mayo JR, Clifton JC, Powell TI, et al. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection. Radiology. 2009;250:576–85.CrossRefPubMedGoogle Scholar
  21. 21.
    Lewis RJ, Caccavale RJ, Bocage J, Widmann MD. Video assisted thoracic surgical non rib spreading simultaneously stapled lobectomy. Chest. 1999;116:119–1124.CrossRefGoogle Scholar
  22. 22.
    Walker WS. Video-assisted thoracic surgery (VATS) lobectomy: the Edinburgh experience. Semin Thorac Cardiovasc Surg. 1998;10:291–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Kaseda S, Aoki T, Hangai N. Video-assisted thoracic surgery (VATS) lobectomy: the Japanese experience. Semin Thorac Cardiovasc Surg. 1998;10:300–4.CrossRefPubMedGoogle Scholar
  24. 24.
    McKenna RJ, Wolf RK, Brenner M, Fischel RJ, Wurnig P. Is lobectomy by video-assisted thoracic surgery an adequate cancer operation? Ann Thorac Surg. 1998;66:1903–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Yim AP, Liu HP. Thoracoscopic major lung resection-indications, technique and early results: experience from two centers in Asia. Surg Laparosc Endosc. 1997;7:241–4.CrossRefPubMedGoogle Scholar
  26. 26.
    McKenna Jr RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81:421–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH, D’Amico TA. Thoracoscopic lobectomy is a safe and versatile procedure. Ann Surg. 2006;244:420–5.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Giudicelli R, Thomas P, Lonjon T, Ragni J, Morati N, Ottomani R, et al. Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy. Ann Thorac Surg. 1994;58:712–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Kirby TJ, Mack MJ, Landreneau RJ, Rice TW. Lobectomy–video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg. 1995;109:997–1001.CrossRefPubMedGoogle Scholar
  30. 30.
    Ohbuchi T, Morikawa T, Takeuchi E, Kato H. Lobectomy: video-assisted thoracic surgery versus posterolateral thoracotomy. Jpn J Thorac Cardiovasc Surg. 1998;46:519–22.CrossRefPubMedGoogle Scholar
  31. 31.
    Demmy TL, Curtis JJ. Minimally invasive lobectomy directed toward frail and high-risk patients: a case–control study. Ann Thorac Surg. 1999;68:194–200.CrossRefPubMedGoogle Scholar
  32. 32.
    Nagahiro I, Andou A, Aoe M, Sano Y, Date H, Shimizu N. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg. 2001;72:362–5.CrossRefPubMedGoogle Scholar
  33. 33.
    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.CrossRefPubMedGoogle Scholar
  34. 34.
    Kaseda S, Aoki T, Hangai N, Shimizu K. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg. 2000;70:1644–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Walker WS, Codispoti M, Soon SY, Stamenkovic S, Camochan F, Pugh G. Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothorac Surg. 2003;23:397–402.CrossRefPubMedGoogle Scholar
  36. 36.
    Thomas P, Doddoli C, Yena S, Thirion X, Sebag F, Fuentes P, Giudicelli R. VATS is an adequate oncological operation for stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2002;21:1094–9.CrossRefPubMedGoogle Scholar
  37. 37.
    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;24:27–31.CrossRefPubMedGoogle Scholar
  38. 38.
    Whitson BA, Andrade RS, Boettcher A, Bardales R, Kratzke RA, Dahlberg PS, Maddaus MA. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg. 2007;83:1965–70.CrossRefPubMedGoogle Scholar
  39. 39.
    Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. 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;86:2008–18.CrossRefPubMedGoogle Scholar
  40. 40.
    Park BJ, Zhang H, Rusch VW, Amar D. Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy. J Thorac Cardiovasc Surg. 2007;133:775–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Villamizar NR, Darrabie MD, Burfeind WR, Peterson RP, Onaitis MW, Toloza E, et al. Thoracoscopic lobectomy is associated with lower morbidity compared with thoracotomy. J Thorac Cardiovasc Surg. 2009;138:419–25.CrossRefPubMedGoogle Scholar
  42. 42.
    Koren JP, Bocage JP, Geis WP, Caccavale RJ. Major thoracic surgery in octogenarians. The video-assisted thoracic surgery (VATS) approach. Surg Endosc. 2003;17:632–5.CrossRefPubMedGoogle Scholar
  43. 43.
    McVay CL, Pickens A, Fuller C, Houck W, McKenna R. VATS anatomic pulmonary resection in octogenarians. Am Surg. 2005;71:791–3.PubMedGoogle Scholar
  44. 44.
    Koizumi K, Haraguchi S, Hirata T, Hirai K, Mikami I, Fukushima M, et al. Lobectomy by video-assisted thoracic surgery for lung cancer patients aged 80 years or more. Ann Thorac Cardiovasc Surg. 2003;9:14–21.PubMedGoogle Scholar
  45. 45.
    Cattaneo SM, Park BJ, Wilton AS, Seshan VE, Bains MS, Downey RJ, et al. Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg. 2008;85:231–6.CrossRefPubMedGoogle Scholar
  46. 46.
    Landreneau RJ, Hazelrigg SR, Mack MJ, Dowling RD, Burke D, Gavlick J, et al. Postoperative pain-related morbidity: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 1993;56:1285–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Stammberger U, Steinacher C, Hillinger S, Schmid RA, Kinsbergen T, Weder W. Early and long-term complaints following video-assisted thoracoscopic surgery: evaluation in 173 patients. Eur J Cardiothorac Surg. 2000;18:7–11.CrossRefPubMedGoogle Scholar
  48. 48.
    Suguira H, Morikawa T, Kaji M, Sasamura Y, Kondo S, Katoh H. Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surg Laparosc Endosc Percutan Tech. 1999;9:403–8.Google Scholar
  49. 49.
    Li WW, Lee TW, Lam SS, NG CS, Sihoe AD, Wan IY, Yim AP. Quality of life following lung cancer resection. Chest. 2002;122:584–9.CrossRefPubMedGoogle Scholar
  50. 50.
    The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. N Engl J Med. 2004;350:351–60.CrossRefGoogle Scholar
  51. 51.
    Winton T, Livingston R, Johnson D, Rigas J, Johnston M, Butts C, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med. 2005;352:2589–97.CrossRefPubMedGoogle Scholar
  52. 52.
    Petersen RP, Pham D, Burfeind WR, Hanish SI, Toloza EM, Harpole DH, D’Amico TA. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg. 2007;83:1245–50.CrossRefPubMedGoogle Scholar
  53. 53.
    Nicastri DG, Wisnivesky JP, Little V, Yun J, Chin C, Dembitzer FR, Swanson SJ. Thoracoscopic lobectomy: report on safety, discharge independence, pain and chemotherapy tolerance. J Thorac Cardiovasc Surg. 2008;135:642–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non small cell lung cancer. Lung cancer study group. Ann Thorac Surg. 1995;60:615–22.CrossRefPubMedGoogle Scholar
  55. 55.
    Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1N0M0 small sized lung cancer. J Thorac Cardiovasc Surg. 2003;125:924–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Watanabe T, Okada A, Imakire T, et al. Intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. Jpn J Thorac Cardiovasc Surg. 2005;53:29–35.CrossRefPubMedGoogle Scholar
  57. 57.
    McKenna RJ, Mahtabifard A, Pickens A, Kusuanco D, Fuller CB. Fast-tracking after video-assisted thoracoscopic surgery lobectomy, segmentectomy and pneumonectomy. Ann Thorac Surg. 2007;84:1663–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, Higami T. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg. 2009;35:775–80.CrossRefPubMedGoogle Scholar
  59. 59.
    Schuchert MJ, Pettiford BL, Keeley S, D’Amato TA, Kilic A, Close J, et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg. 2007;84:926–33.CrossRefPubMedGoogle Scholar
  60. 60.
    Atkins BZ, Harpole DH, Mangum JH, Toloza EM, D’Amico TA, Burfeind WR. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg. 2007;84:1107–13.CrossRefPubMedGoogle Scholar
  61. 61.
    Shapiro M, Weiser T, Wisnivesky JP, Chin C, Arustmyan M, Swanson S. Thoracoscopic segmentectomy compares favorably with thoracoscopic lobectomy for patients with small stage I lung cancer. J Thorac Cardiovasc Surg. 2009;137:1388–93.CrossRefPubMedGoogle Scholar
  62. 62.
    Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence and telementoring. Surg Endosc. 2002;16:1389–402.CrossRefPubMedGoogle Scholar
  63. 63.
    Mohr FW, Falk V, Diegeler A, Walther T, Gummert JF, Bucerius J, et al. Computer-enhanced “robotic” cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg. 2001;121:842–53.CrossRefPubMedGoogle Scholar
  64. 64.
    Melfi FM, Menconi GF, Mariani AM, Angeletti CA. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg. 2002;21:864–8.CrossRefPubMedGoogle Scholar
  65. 65.
    Morgan JA, Ginsburg ME, Sonett JR, Argenziano M. Advanced thoracoscopic procedures are facilitated by computer-aided robotic technology. Eur J Cardiothorac Surg. 2003;23:883–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Bodner J, Wykypiel H, Wetscher G, Schmid T. First experiences with the da Vinci™ operating robot in thoracic surgery. Eur J Cardiothorac Surg. 2004;25:844–51.CrossRefPubMedGoogle Scholar
  67. 67.
    Gharagozloo F, Margolis M, Tempesta B, Strother E, Najam F. Robot-assisted lobectomy for early-stage lung cancer: report of 100 consecutive cases. Ann Thorac Surg. 2009;88:380–4.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of SurgeryHackensack University Medical CenterHackensackUSA

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