Comparative Analysis of Video-Assisted Thoracoscopic Surgery and Open Thoracotomy for Early-Stage Non-Small Cell Lung Cancer: Review
Downloads
Video-assisted thoracoscopic surgery (VATS) has increasingly become the modality of choice in the management of patients with early-stage non‑small cell lung cancer (NSCLC). Morbidity and hospitalisation are always lower and shorter in persons undergoing VATS when compared to persons undergoing conventional thoracotomy in systematic reviews. However, it is essential to note that few randomized controlled trials specifically assessing long-term oncologic outcomes exist. The current review is therefore aimed at evaluating and summarizing the literature published over the last decade, with a focus on cancer-free survival, overall survival, postoperative complications, and health-related quality of life. It is limited to situations where lobectomy or segmentectomy was done with a curative intent that was final and where there was a need to compare the VATS technique and open thoracotomy in the environment of early-stage NSCLC. In addition, new surgical methods and the multifactorial determinants influencing the cost-effectiveness of every operative approach will be discussed.
1. Y. Cai, X. Fu, Q. Xu, W. Sun et al., "Thoracoscopic Lobectomy versus Open Lobectomy in Stage I Non-Small Cell Lung Cancer: A Meta-Analysis," 2013. ncbi.nlm.nih.gov
2. R. Afghani, R. Bagheri, and F. Golhasani Keshtan, "Analysis of the Results of Pulmonary Resection by Minimally Invasive Thoracoscopy for the Surgical Treatment of Lung Cancer," 2018. [PDF]
3. B. Zhang, Q. Xiao, H. Xiao, J. Wu, D. Yang, "Perioperative outcomes of video-assisted thoracoscopic surgery versus open thoracotomy after neoadjuvant chemoimmunotherapy in resectable NSCLC," Frontiers in ..., 2022. nih.gov
4. D. Kim, W. Woo, J. I. Shin, and S. Lee, "The uncomfortable truth: open thoracotomy versus minimally invasive surgery in lung cancer: a systematic review and meta-analysis," Cancers, 2023. mdpi.com
5. K. Hireche, Y. Lounes, C. Bacri, L. Solovei et al., "VATS versus Open Lobectomy following Induction Therapy for Stage III NSCLC: A Propensity Score-Matched Analysis," 2023. ncbi.nlm.nih.gov
6. G. R. Rodriguez, J. Kucera, J. L. Antevil, et al., "Contemporary video-assisted thoracoscopic lobectomy for early-stage lung cancer," *Journal of Surgical Research*, vol. 2024. [HTML]
7. P. Hazrah, S. Jain, D. Sharma, and P. K. Singh, "Techniques for Perioperative Localization of Pulmonary Nodules for Precision Resection in VATS and Robot-Assisted Thoracoscopic Surgery: An Overview," Minimal Access Surgery, vol. 2025, Springer. [HTML]
8. H. Kwan Kim, "Video-Assisted Thoracic Surgery Lobectomy," 2021. ncbi.nlm.nih.gov
9. V. Erdogu, H. Akin, Y. Sonmezoglu, A. Cevat Kutluk et al., "Comparison of the Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non-Small Cell Lung Cancer: Single Cohort Study with 269 Cases," 2020. ncbi.nlm.nih.gov
10. C. H. U. N. H. U. A. LIU, Z. H. O. N. G. D. O. N. G. LI, C. U. I. Q. I. N. G. BAI, L. I. WANG et al., "Video-assisted thoracoscopic surgery and thoracotomy during lobectomy for clinical stage I non-small-cell lung cancer have equivalent oncological outcomes: A single-center experience of 212 consecutive resections," 2015. ncbi.nlm.nih.gov
11. A. L. Potter, A. Spasojevic, V. Raman, J. C. Hurd, "The increasing adoption of minimally invasive lobectomy in the United States," The Annals of Thoracic Surgery, vol. 2023, Elsevier. annalsthoracicsurgery.org
12. M. A. Napolitano, A. D. Sparks, G. Werba, et al., "Video-assisted thoracoscopic surgery lung resection in United States veterans: trends and outcomes versus thoracotomy," *The Thoracic and Cardiovascular Surgeon*, vol. 2022. [HTML]
13. L. Bertolaccini, G. Fornaro, O. Ciani, E. Prisciandaro, et al., "The impact of surgical experience in VATS lobectomy on conversion and patient quality of life: Results from a comprehensive national video-assisted thoracic …," Cancers, vol. 2023. mdpi.com
14. W. Chen, K. Jin, Z. Yu, and H. Liu, "Analysis of risk factors and management of unexpected intraoperative bleeding during video-assisted thoracic surgery for non-small cell lung cancer: a case-control …," Journal of Thoracic Disease, 2023. nih.gov
15. H. Jeong, J. W. Choi, H. J. Ahn, J. Choi, and J. H. Park, "Prediction of pleural adhesions by lung ultrasonography: an observational study," *Journal of Cardiothoracic and …*, vol. 2021, Elsevier. [HTML]
16. IEWG Laven, JHT Daemen, N Janssen, "Risk of pneumothorax requiring pleural drainage after drainless VATS pulmonary wedge resection: a systematic review and meta-analysis," 2022. researchgate.net
17. B. C. Bade, J. D. Blasberg, V. J. Mase Jr., "A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence," *Journal of Thoracic Surgery*, vol. 2022. nih.gov
18. F. C. Detterbeck, V. J. Mase Jr., A. X. Li, "… I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally …," Journal of Thoracic, vol. 2022. nih.gov
19. P. A. Thomas, A. L. Couderc, D. Boulate, L. Greillier, et al., "Early-stage non-small cell lung cancer beyond life expectancy: Still not too old for surgery?," Lung Cancer, vol. 2021, Elsevier. sciencedirect.com
20. J. Yun, J. Lee, S. Shin, H. Kwan Kim et al., "Video-assisted thoracoscopic lobectomy versus open lobectomy in the treatment of large lung cancer: propensity-score matched analysis," 2022. ncbi.nlm.nih.gov
21. H. H. Elsayed and A. A. Moharram, "Tailored anaesthesia for thoracoscopic surgery promoting enhanced recovery: The state of the art," Anaesthesia Critical Care & Pain Medicine, 2021. [HTML]
22. N. A. Kerna, S. Chawla, N. D. V. Carsrud, et al., "Sound therapy: vibratory frequencies of cells in healthy and disease states," EC Clinical and Experimental Oncology, vol. 2022. researchgate.net
23. C. Forster, A. Hasenauer, J. Y. Perentes, et al., "Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection," *Journal of Thoracic Surgery*, 2022. nih.gov
24. C. Galata, I. Karampinis, E. D. Roessner, et al., "Risk factors for surgical complications after anatomic lung resections in the era of VATS and ERAS," *Thoracic Surgery*, vol. 2021, Wiley Online Library. wiley.com
25. A. L. Soilly, L. Serge Aho Glélé, A. Bernard, H. Abou Hanna et al., "Medico-economic impact of thoracoscopy versus thoracotomy in lung cancer: multicentre randomised controlled trial (Lungsco01)," 2023. ncbi.nlm.nih.gov
26. W. Chen, Z. Yu, Y. Zhang, and H. Liu, "Comparison of cost effectiveness between video-assisted thoracoscopic surgery (vats) and open lobectomy: a retrospective study," 2021. ncbi.nlm.nih.gov
27. L. H. Qiu, S. H. Liang, L. Wu, Y. Y. Huang, "Longitudinal assessment of quality of life indicators and prognosis in esophageal cancer patients with curative resection," Journal of Thoracic, 2024. nih.gov
28. AJ Van Nieuwenhuizen, LM Buffart, JA Langendijk, et al., "Health-related quality of life and overall survival: a prospective study in patients with head and neck cancer treated with radiotherapy," Quality of Life Research, vol. 30, no. 5, pp. 1301-1311, 2021. springer.com
29. B. Yang, F. Zhao, Z. Zong, J. Yuan et al., "Preferences for treatment of lobectomy in Chinese lung cancer patients: video-assisted thoracoscopic surgery or open thoracotomy?," 2014. ncbi.nlm.nih.gov

