Video-assisted thoracoscopic surgery lobectomy with chest wall resection

Abstract

Lung cancer presents with chest wall invasion in 5-8% of patients, which imparts some treatment challenges. Surgical resection is currently the standard of care, and there are some controversies regarding the best approach. Published series and case reports confirm the safety and feasibility of video-assisted thoracoscopic surgery (VATS) in highly complex surgical cases including lobectomy with chest wall resection of locally advanced lung cancer. In this article, we present the clinical indications of locally advanced lung cancer that infiltrates the chest wall, the modalities for and importance of accurately staging lung cancers with chest wall invasion, and the technical aspects of accomplishing a safe and oncologically sound extended resection through VATS.

Video-assisted thoracoscopic segmentectomy with combined chest wall resection: A case report

“…Lobectomy with combined resection is the standard surgical procedure for NSCLC showing invasion of the adjacent organs. Minimally invasive techniques for lung cancer with chest wall invasion have been reported to reduce surgical stress (3)(4)(5)(6)(7). Cerfolio a "minimally invasive chest wall resection, " which eliminated cutting of the extrathoracic (trapezius, rhomboid, and serratus anterior) muscles (4).…”

“…As described by Dal Agnol et al, reconstruction of the chest wall was not performed because the tumor was located posteriorly and above the 5th rib; thus, the chest wall defect was covered and protected by the scapula and overlying muscles (5). For tumors widely invading the dorsal part of the central ribs, this technique may not be applicable.…”

Robotic Surgery for Non-Small Cell Lung Cancer

“…The technique was quickly adapted to lobectomy in elderly patients with early-stage NSCLC, where some of the first cases were completed with similar or better results to historical controls [7]. Since these initial reports, VATS surgery has become increasingly common, with expanded use in complex lung resections, pneumonectomy, bronchovascular sleeve resections, and tumors that include the chest wall [8][9][10]. While only 8% of lobectomies in the United States were performed thoracoscopically in 2003, this figure has increased significantly over time, up to 54% as reported in 2014, especially among high-volume surgeons [11][12][13].…”