Minimally invasive surgical approaches for lung cancer

ABSTRACT

Introduction: Surgery is the standard of care for early-stage non-small cell lung cancer (NSCLC), but there remains on an ongoing discussion as to what is the best surgical approach. Despite only modest adoption of minimally invasive surgery (MIS), it is now the favored approach over traditional open surgery. MIS techniques like video-assisted (VATS) and robot-assisted thoracoscopic surgery (RATS) have been demonstrated to reduce postoperative complications and shorten the length of hospitalization. Furthermore, despite unresolved questions of the oncological equivalency of MIS approaches, recent literature suggests no differences in upstaging or survival between VATS and open surgery.

Area covered: We examine the current state and future direction of MIS for lung cancer in this review.

Expert opinion: The perioperative benefits of VATS may make it superior to thoracotomy. There is overall insufficient clinical and patient equipoise to support a large randomized trial comparing MIS with open surgery at this time, but this may change in the presence of compelling preliminary data. The growing use of RATS has thus far only shown equivalence to VATS at a higher cost. Further investigation is needed.

Trial registration: ClinicalTrials.gov identifier: NCT02617186.

KEYWORDS:

• Minimally invasive surgery (MIS)
• video-assisted thoracoscopic surgery (VATS)
• robot-assisted thoracoscopic surgery (RATS)
• uniportal surgery
• lung cancer
• non-small cell lung cancer (NSCLC)
• hybrid operating room
• image-guided therapy
• navigation surgery
• artificial interfaces (AI)

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.