Portal de Periódicos da CAPES

Video-assisted thoracoscopic surgery (VATS) for locally advanced lung cancer.

2012; National Institutes of Health; Linguagem: Inglês

10.3978/j.issn.2225-319x.2012.03.05

Mark Hennon, Todd L. Demmy,

Head and Neck Cancer Studies

Initial fears regarding the oncologic equivalence of the thoracoscopic and open techniques for resecting NSCLC have not been realized. Reported data to date indicate that even in advanced NSCLC requiring pneumonectomy, the overall and disease free survival are equivalent for patients undergoing VATS versus thoracotomy. Furthermore, these results have occurred during a time where the complex procedures are still in a relatively early stage of refinement and we sense that results will improve as we make adjustments to speed the operations and further reduce conversions and complications. VATS lobectomy for early stage disease produces oncologically similar results with open techniques, and long term studies will determine if the same hold true for more advanced case. Early indications are favorable. This finding is in accordance with others who have hypothesized that the reduced inflammatory response associated with thoracoscopy may be associated with equivalent or even improved long-term survival (22,23). VATS lobectomy, pneumonectomy, and chest wall resection for advanced lung cancer can be performed safely with an acceptable mortality rate. VATS offers the benefit of increased tolerance for adjuvant therapy so if high VATS reliability is achieved, it may be reasonable someday to consider resection first for some patients who currently undergo induction chemoradiotherapy for their disease. The low morbidity of VATS reported for early stage lung carcinoma, though not definitively proven for advanced stage NSCLC, will be expected as experience builds. Further analyses of outcomes for thoracoscopic resection of advanced stage disease are ongoing. This is particularly important given the large number of frail patients with advanced stage disease who require multimodality therapy, which can be difficult to tolerate. Conversions, though increased in frequency, are not associated with a significant change in short-term or long-term outcomes. Continued improvements in instrument technology and surgical technique will only continue to expand the possibilities for minimally invasive pulmonary resections, as well as those for primary chest wall tumors.