Supplement: 2nd International Bi-Annual Minimally Invasive Thoracic Surgery Summit
Section II: Lung cancer treatment
Is VATS Lobectomy Better: Perioperatively, Biologically and Oncologically?

Presented at the 2nd International Bi-Annual Minimally Invasive Thoracic Surgery Summit, Boston, MA, October 9–10, 2009.
https://doi.org/10.1016/j.athoracsur.2010.03.020Get rights and content

The current review focuses on a clinical comparison of lobectomy by means of video-assisted thoracoscopic surgery (VATS) and open lobectomy. The best available evidence strongly suggests that VATS lobectomy is less morbid than open lobectomy, and that VATS lobectomy is less immunosuppressive and elicits a milder inflammatory response than open lobectomy. Midterm to long-term oncologic results of patients with early-stage non–small cell lung cancer appear to be equivalent for VATS and open lobectomy. Because a large, prospective, randomized, multiinstitutional trial of open versus VATS lobectomy will likely never take place, we are dependent on the summarized information to draw practical conclusions.

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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

References (32)

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