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VATS LOBECTOMY

Video-assisted thoracic surgery (VATS) lobectomy has been used in the treatment of resectable lung cancer since the early 1990s. While substantial evidence has accrued in the literature to demonstrate superiority of lobectomy over wedge resection in most patients, there are no large prospective, randomized studies favoring video-assisted lobectomy over conventional lobectomy by thoracotomy.1 There are several large single and multicenter series that support the use of VATS lobectomy technique over lobectomy by thoracotomy (Table 73-1). From these data, as well as data from several exclusive VATS series, it is clear that VATS lobectomy is technically feasible and safe and provides improved outcomes in terms of all parameters measured such as morbidity, mortality, length of stay, functional recovery, and quality of life in appropriately selected patients with resectable non–small-cell lung cancer (NSCLC). Even for patients with locally advanced NSCLC who undergo preoperative chemotherapy, VATS lobectomy is feasible and effective, without compromising oncologic outcomes.2

Table 73-1SELECTED VATS LOBECTOMY VERSUS THORACOTOMY (THOR) SERIES

Despite the growing body of evidence to demonstrate their feasibility, safety, and oncologic efficacy, VATS lobectomies represented only about 46% of all lobectomies performed in the United States as ...

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