Video-Assisted Thoracic Surgery for Lung Cancer Resection

Abstract

Objective The purpose of this consensus conference was to determine whether video-assisted thoracic surgery (VATS) improves clinical and resource outcomes compared with conventional thoracotomy (OPEN) in adults undergoing lobectomy for lung cancer, and to outline evidence-based recommendations for the use of VATS in performing lobectomy for lung cancer. Methods Before the consensus conference, the best available evidence was reviewed in that systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. At the consensus conference, evidence-based statements were created, and consensus processes were used to determine the ensuing recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of recommendation. Results and Recommendations The consensus panel agreed upon the following statements and recommendations in patients with clinical stage I nonsmall cell lung cancer undergoing lung lobectomy: 1. VATS can be recommended to reduce overall postoperative complications (class IIa, level A evidence). 2. VATS can be recommended to reduce pain and overall functionality over the short term (class IIa, level B evidence). 3. VATS can be recommended to improve delivery of adjuvant chemotherapy delivery (class IIa, level B evidence). 4. VATS can be recommended for lobectomy in clinical stage I and II non-small cell lung cancer patients, with no proven difference in stage-specific 5-year survival compared with open thoracotomy (class IIb, level B evidence).