A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether a VATS lobectomy produces an equivalent cancer clearance compared to an open technique. Using the reported search 409 papers were identified. Twenty-one papers represented the best evidence on the subject from which 15 are fully tabulated. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. We conclude that repeated cohort studies have shown 5-year survival rates similar in the VATS groups to that achieved from open thoracotomy. The majority of resections are in Stage I tumours <3-5 cm in size and five-year survival rates of 70% or better have consistently been reported. It is reasonable to assume that this cancer cure is similar to open resection although it must be remembered that significant selection bias occurs in all these non-randomized studies. A few case reports have raised concerns about port site recurrence and seeding with VATS but the incidence of incision recurrence in open procedures is also unknown. Finally, there is little data to support improved hospital stay, reduced costs or improved patient experience with VATS, and thus, while equivalence has been well shown with the open technique, further randomized studies are required to demonstrate superiority.

Liver resection has been associated with significant morbidity and mortality due to hepatic dysfunction or hepatic failure in the postoperative period. Autologous bone marrow stem cell (BMSC) therapy may offer the potential to enhance hepatic regeneration in this setting, perhaps increasing the safety of the procedure. Preclinical models and initial translational studies have suggested that autologous BMSC administration can facilitate hepatic regeneration following both acute and chronic liver disease. While translational studies have begun in chronic hepatic disease, translation to hepatic surgical indications has been limited. This review explores the practical barriers currently restricting the delivery of autologous stem cell therapies to enhance hepatic regeneration following liver resection including selection of cell type, cell isolation, therapy delivery, trial design, and assessment of efficacy.

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