Surgical options to early-stage lung cancer: can "the less" mean "the safe"?

Lung cancer is the leading cause of death for solid tumors worldwide. Approximately 5-10% of patients present with an early stage tumor and can undergo radical surgery. There are different kinds of thoracotomies depending on the location of surgical entry and how much lung is removed. At the present, lobectomy is the standard procedure to remove early stage lung cancer. Two options can be performed: i) open lobectomy, through which a lobe of the lungs is removed through a long incision on the side of the chest (thoracotomy); ii) video-assisted thoracoscopic surgical (VATS) procedure which allows the lobe removal through a few small incisions in the chest with the assistance of instruments and a camera. Here we discuss and analyze the findings of a paper by Subroto and colleagues, recently published by the British Medical Journal which compares long term survival after minimally invasive lobectomy and thoracotomy lobectomy, by using a propensity matched approach. Although some methodological limitation, the study findings point out that between the two techniques there are no differences regarding the outcome, but the minor comorbidity associated to VATS. Further investigation in the form of a randomized controlled trial are thus needed to assure to ​VATS wider indications in thoracic oncology.