Video-assisted Thoracic Surgery Versus Thoracotomy for Non-small-cell Lung Cancer

  • Pan, Tie-Wen (Department of Thoracic Surgery, Shanghai Changzheng Hospital) ;
  • Wu, Bin (Department of Thoracic Surgery, Shanghai Changzheng Hospital) ;
  • Xu, Zhi-Fei (Department of Thoracic Surgery, Shanghai Changzheng Hospital) ;
  • Zhao, Xue-Wei (Department of Thoracic Surgery, Shanghai Changzheng Hospital) ;
  • Zhong, Lei (Department of Thoracic Surgery, Shanghai Changzheng Hospital)
  • Published : 2012.02.29


Video-assisted thoracic surgery (VATS) has been recommended as more optimal surgical technique than traditional thoracotomy for lobectomy in lung cancer, but it is not well defined. Here, we compared VATS and traditional thoracotomy based on clinical data. From November 2008 to November 2010, 180 patients underwent lobectomy for non-small-cell lung cancer (NSCL) identified by computerized tomography. Of them, 83 cases were performed with VATS and 97 by thoracotomy. Clinical parameters, consisting of blood loss, operating time, number of lymph node dissection, days of pleural cavity drainage, and length of stay were recorded and evaluated with t test. No significant difference was observed between the VATS and thoracotomy groups in the average intraoperative blood loss, number of lymph node dissections, and days of pleural cavity drainage. While the average operating time in the VATS group was significantly longer than that in thoracotomy group, recurrence was only present in one case, as opposed to 7 cases in the thoracotomy group In conclusion, similar therapeutic effects were demonstrated in VATS and thoracotomy for NSCL. However, VATS lobectomy was associated with fewer complications, recurrence and shorter length of stay.


Video-assisted thoracic surgery;thoracotomy;length of stay;recurrence


  1. Bach PB, Jett JR, Pastorino U, et al (2007). Computed tomography screening and lung cancer outcomes. JAMA, 297, 953-61.
  2. Baysungur V, Tezel, Okur E, et al (2011). Quality of life assessment six months after lobectomy for lung cancer: video-assisted thoracoscopic surgery versus thoracotomy. Turkish J Thorac Cardiovasc Surg, 19, 207-12.
  3. Boffa DJ, Allen MS, Grab JD, et al (2008). Data from the Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg, 135, 247-54.
  4. Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS (2001). Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg, 20, 455-63.
  5. Debevec L, Er en J, Debeljak A, Crnjac A, Kova V (2006). Exploratory thoracotomy and its influence on the survival of patients with lung cancer. Wiener Klinische Wochenschrift, 118, 479-84.
  6. Demmy TL, Nwogu C (2008). Is video-assisted thoracic surgery lobectomy better? Quality of life considerations. Ann Thorac Surg, 85, S719-28.
  7. Flores RM, Park BJ, Dycoco J, et al (2009). Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg, 138, 11-8.
  8. McKenna Jr RJ, Houck W, Fuller CB (2006). Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg, 81, 421-6.
  9. Moffatt SD, Mitchell JD, Whyte RI (2002). Role of videoassisted thoracoscopic surgery and classic thoracotomy in lung cancer management. Curr Opin Pulm Med, 8, 281-6.
  10. Muraoka M, Oka T, Akamine S, et al (2006). Video-assisted thoracic surgery lobectomy reduces the morbidity after surgery for stage I non-small cell lung cancer. Jpn J Thorac Cardiovasc Surg, 54, 49-55.
  11. Nicastri DG, Wisnivesky JP, Litle VR, et al (2008). Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg, 135, 642-7.
  12. Ohtsuka T, Nomori H, Horio H, Naruke T, Suemasu K (2004). Is major pulmonary resection by video-assisted thoracic surgery an adequate procedure in clinical stage I lung cancer? Chest, 125, 1742-6.
  13. Petersen RP, Pham DK, Burfeind WR, Hanish SI, Toloza EM, Harpole DH (2007). Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg, 83, 1245-50.
  14. Pieterman RM, van Putten JWG, Meuzelaar JJ, et al (2000). Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med, 343, 254-61.
  15. Porte HL, Ernst OJ, Delebecq T, et al (1999). Is computed tomography guided biopsy still necessary for the diagnosis of adrenal masses in patients with resectable non-small-cell lung cancer? Eur J Cardiothorac Surg, 15, 597-601.
  16. Sagawa M, Sato M, Sakurada A, et al (2002). A prospective trial of systematic nodal dissection for lung cancer by videoassisted thoracic surgery: can it be perfect? Ann Thorac Surg, 73, 900-4.
  17. Sakuraba M, Miyamoto H, Oh S, et al (2007). Video-assisted thoracoscopic lobectomy vs. conventional lobectomy via open thoracotomy in patients with clinical stage IA nonsmall cell lung carcinoma. Interact Cardiovasc Thorac Surg, 6, 614-7.
  18. Saunders M, Dische S, Barrett A, et al (1997). Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. Lancet, 350, 161-5.
  19. Shennib H, Bogart J, Herndon I, et al (2005). Video-assisted wedge resection and local radiotherapy for peripheral lung cancer in high-risk patients: the Cancer and Leukemia Group B (CALGB) 9335, a phase II, multi-institutional cooperative group study. J Thorac Cardiovasc Surg, 129, 813-8.
  20. Shiraishi T, Hiratsuka M, Yoshinaga Y, et al (2008). Thoracoscopic lobectomy with systemic lymph node dissection for lymph node positive non-small cell lung cancer-is thoracoscopic lymph node dissection feasible? Thorac Cardiovasc Surg, 56, 162-6.
  21. Sugi K, Kaneda Y, Esato K (2000). Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg, 24, 27-31.
  22. Swensen SJ, Jett JR, Hartman TE, et al (2005). CT screening for lung cancer: five-year prospective experience1. Radiology, 235, 259-65.
  23. Swensen SJ, Jett JR, Sloan JA, et al (2002). Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med, 165, 508-13.
  24. Thomas P, Doddoli C, Yena S, et al (2002). VATS is an adequate oncological operation for stage I non-small cell lung cancer. Eur J Cardiothorac Surg, 21, 1094-9.
  25. Walker WS (1998). Video-assisted thoracic surgery (VATS) lobectomy: the Edinburgh experience, Semin Thorac Cardiovasc Surg, 10, 291-9.
  26. Whitson BA, D'Cunha J, Andrade RS, et al (2008). Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Annals Thorac Surg, 86, 1735-44.
  27. Yang X, Wang S, Qu J (2009). Video-assisted thoracic surgery (VATS) compares favorably with thoracotomy for the treatment of lung cancer: a five-year outcome comparison. World J Surg, 33, 1857-61.

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