Minimal invasive surgery in locally advanced N2 non-small cell lung cancer

Abstract

Locally advanced lung cancer, defined by nodal involvement in upper mediastinal stations (N2) (stage IIIA-N2), includes a wide spectrum of patients with multiple therapeutic alternatives. Such heterogeneity is explained, at least in part, by tumor size and magnitude of mediastinal nodal involvement.In this setting, many variants can influence the prognosis, such as the specific nodal stations compromised, the burden of mediastinal disease, and the presence of skip metastasis. In the surgical field, the advent of minimally invasive techniques, including video-assisted thoracoscopic and robotic surgery, have revolutionized the management of early-stage lung cancer, but implementations of these approaches in the locally advanced setting have been erratic. This review attempts to highlight the most relevant scientific data of the surgical management of locally advanced lung cancer patients, analyzing not only the medical evidence but also the cost-effectiveness and accessibility.

Perioperative and Oncological Outcomes of Robotic-Assisted, Video-Assisted Thoracoscopic and Open Lobectomy for Patients with N1-Metastatic Non-Small Cell Lung Cancer: A Propensity Score-Matched Study

“…Although RATL has been widely accepted to be safe and effective for lobectomy and is being widely applied in treating early stage NSCLC, its application in advanced-stage NSCLC is still controversial [ 19 ]. Several retrospective studies have indicated RATL to be feasible and oncologically effective for the treatment of N2 NSCLC [ 8 , 14 , 20 ]. Recently, our team conducted a multicenter, randomized, controlled trial, which suggested that RATL improved perioperative outcomes and achieves similar long-term outcomes compared with open thoracotomy for clinical-N2 NSCLC patients [ 13 , 15 ].…”

“…Despite open lobectomy (OL) still being the standard surgical procedure, video-assisted thoracoscopic lobectomy (VATL), a minimally invasive surgery (MIS) technique, has also been widely used for locally advanced NSCLC [ 6 ]. Multiple studies have indicated that VATL could reduce perioperative complications and short-term morbidities and also achieve comparable long-term outcomes to OL for NSCLC patients with positive N1 and/or N2 LNs, suggesting that MIS may be a favorable surgical approach for locally advanced NSCLC [ 7 , 8 ].…”

Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study

“…However, lung cancer surgery can lead to severe postoperative pain [ 3 ]. With the popularization of video-assisted thoracoscopic minimally invasive surgery, the degree of postoperative pain has decreased compared with the degree of postoperative pain after open surgery, which is mainly due to the use of completely non-rib-spreading techniques [ 4 ]. Furthermore, with the widespread use of uniportal video-assisted thoracoscopic surgery (UVATS) techniques, postoperative pain is further relieved, which is mainly due to the minimal invasiveness of UVATS [ 5 ].…”

Robotic versus Open Surgery in Locally Advanced Non-Small Cell Lung Cancer: Evaluation of Surgical and Oncological Outcomes

“…The surgeon, by performing procedures with the robotic system, is able to achieve more accurate dissection, with consequent proper completeness of resection, precise pathological stage of the disease and favourable postoperative outcomes, as our experience has also confirmed. Furthermore, the minimally invasive approach may play a relevant role in the optimization of therapy, reducing postoperative recovery and allowing the appropriate timing of adjuvant therapy [27].…”