Thoracoscopic versus open lobectomy: short-term outcomes

Maria Giovanna Mastromarino, Marco Di Martino, Francesco Carleo, Massimo Osvaldo Jaus, Luigi Carbone, Alessia De Massimi, Lorenzo Salvadori, Stefano Treggiari, Giuseppe Cardillo


Video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage non-small cell lung cancer (NSCLC) has spread worldwide and it has become a safe and viable alternative to thoracotomy. The aim of this review was to analyse the evidence presents in the current literature in order to assess the safety and efficacy of VATS versus open lobectomy, in terms of short-term outcomes. To identify relevant articles for inclusion in our analysis, we performed a search of PubMed/Medline database. We looked for randomized controlled trials, case series and comparative studies that reported outcomes following VATS or open lobectomy for NSCLC. Morbidity rates are reduced to 7.7–24.1% and mortality to 0.8–2.5% by the VATS approach. The reported lower morbidity rates included less intraoperative bleeding; shorter duration of air leak; lower incidence of post-operative pneumonia, atelectasis requiring bronchoscopy and atrial fibrillation. Furthermore, VATS lobectomy showed shorter chest tube duration; shorter length of hospital stays; reduced post-operative pain and inflammation; a better pulmonary function in the early post-operative phase, when compared with thoracotomy. Summarizing, thoracoscopic approach represents a valid alternative technique to treat NSCLC compared with standard thoracotomy; it offers patients a faster recovery and a better quality of life and allows high-risk patients to benefit from curative surgical treatment. VATS lobectomy might become the choice surgical approach for early-stage NSCLC.