What Is the Red Flag for VATS Pneumonectomy? When to Perform or Avoid the Procedure?

Introduction: The safety and efficacy of video-assisted thoracoscopic surgery (VATS) in pneumonectomy for patients with non-small cell lung cancer (NSCLC) were compared with open surgery. Methods: Between January 2020 and October 2024, we conducted a retrospective review of 177 pneumonectomy cases at our center. Fifty-eight cases were performed using VATS (VATS Group), while 119 were performed using thoracotomy (Thoracotomy Group). Results: The average age of the patients was 61.2 ± 8.3 years (range: 39-83), and the majority were male (n = 155, 87.6%). Perioperative blood loss (VATS Group: 152 ± 131 mL, range 100-700 mL versus Thoracotomy Group: 314 ± 455 mL, range 100-3500 mL) and hospital stay durations (VATS Group: 5.3 ± 2.4 days, range 3-13 versus Thoracotomy Group: 7.5 ± 4.1 days, range 2-22) were found to be significantly lower in the VATS Group (P < .001 for both). Left-sided resections were more frequent in the VATS Group (74% versus 57.1%, P = .049), and tumor sizes were observed to be smaller (4.8 ± 2.2 cm versus 6.2 ± 3.6 cm, P = .009). No significant differences were observed between the groups in terms of postoperative early morbidity and 30-day mortality (P = .784 and P = .549, respectively). Conclusion: VATS pneumonectomy is a method that can be preferred by experienced centers in patients with NSCLC, offering the advantages of reduced perioperative bleeding and shorter hospital stays compared with the thoracotomy approach, without compromising oncological principles.