Is video-assisted thoracic surgery lobectomy the best choice for the treatment of lung cancer?

-Video-assisted lobectomy has proved to be safe and effective since it was initially reported in 1994. Over time, many comparative studies have shown that video-assisted thoracic surgery (VATS) lobectomy is better than open lobectomy in terms of postoperative complications and length of hospital stay (LOS). There is also evidence suggesting that acute and chronic postoperative pain rates are lower after VATS lobectomy than after open lobectomy. An accurate lymphadenectomy can be performed easily and safely during VATS lobectomy; however its completeness is still being debated, particularly in terms of peribronchial and hilar lymph node evaluation. Previous data have shown that VATS lobectomy is indicated for the treatment of early stage lung cancer. Long-term oncologic results in patients with early stage non-small cell lung cancer (NSCLC) appear to be comparable between VATS and open lobectomy. Published experiences showing have shown good results after VATS lobectomy for advanced stage lung cancer and after VATS lobectomy associated with bronchoplasty and/or angioplasty have appeared. More recently, cost analysis studies have reported that the overall cost of VATS is similar or less than open lobectomy because of its association with shorter LOS, faster recovery, and fewer adverse events. Moreover, the economic impact of the VATS approach is magnified with increased experience of the surgeon. Nevertheless, to the best of our knowledge, a large prospective and randomized multi-institutional study comparing results of patients undergoing VATS lobectomy with those of patients undergoing open lobectomy has never been conducted. Therefore, a large clinical trial is needed in order to validate the results shown in previous studies and clarify some controversial aspects.