Supplement: 2nd International Bi-Annual Minimally Invasive Thoracic Surgery SummitSection II: Lung cancer treatmentIs VATS Lobectomy Better: Perioperatively, Biologically and Oncologically?
Section snippets
Material and Methods
We performed an extensive review of the currently available English-language literature from 1994 (the year of the first published report on VATS lobectomy) to present. For the purposes of this review, we included the most recently published multiinstitutional trial on open lobectomy for stage I NSCLC and the most recent report published from a national database, thus focusing on data that broadly reflect current national practices. We reviewed retrospective studies on VATS lobectomy that
Video-Assisted Thoracoscopic Surgery Versus Open Lobectomy: Perioperative Perspective
A comparison of perioperative outcomes of VATS versus open lobectomy first requires an overview of the available data on each.
Video-Assisted Thoracoscopic Lobectomy Versus Open Lobectomy: Biologic Perspective
The biologic advantages of VATS lobectomy compared with open lobectomy have been demonstrated in vitro in four studies on acute-phase reactants and cellular immune responses [25, 26, 27, 28]. In summary, these studies show that VATS lobectomy leads to a reduced inflammatory response (lower interleukin and C-reactive protein levels), less postoperative reduction in CD4 and natural killer cells, and less impairment of cellular cytotoxicity than open lobectomy. These findings could partially
Video-Assisted Thoracoscopic Lobectomy Versus Open Lobectomy: Oncologic Perspective
To date, only one small prospective, randomized trial has compared oncologic results of VATS with open lobectomy [29]. In this study published in 2000, Sugi and colleagues reported that for 100 patients with stage IA NSCLC undergoing either open (n = 52) or VATS (n = 48) lobectomy, there was no difference in 3- and 5-year survival rates. Several additional retrospective reports support these findings [19, 30, 31]. In these separate reports, the 5-year survival for VATS lobectomy is near 80%,
Conclusions
Because a large, prospective, randomized, multiinstitutional trial of open versus VATS lobectomy will likely never take place, we are dependent on the herein summarized information to draw clinically applicable conclusions. The currently available clinical evidence indicates that VATS lobectomy for early-stage NSCLC is associated with fewer postoperative complications and less negative biologic impact on patients than open lobectomy. Furthermore, all data to date strongly suggest oncologic
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