Minimally invasive surgical approaches for lung cancer

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.