Trial Information

Feasibility of Video-Assisted Thoracoscopic Surgery for Clinical Stage IIIA Non-Small Cell Lung Cancer

Video-assisted or minimally invasive surgery has become the standard approach for many
abdominal surgical operations such as cholecystectomy and fundoplication. With respect to
the thorax, video-assisted thoracoscopic surgery (VATS) is the accepted technique for biopsy
of the lung and pleura and surgical treatment of pneumothorax. A VATS lobectomy with
systematic node dissection (SND) for non-small cell lung cancer (NSCLC) has been gradually
introduced by many thoracic surgeons since it was first performed in 1995 by McKenna and
associates. They reported that the survival rate for stage I lung cancer is similar between
lobectomies done by VATS and by thoracotomy. Although minimally invasive surgery certainly
sounds good, it is problematic if it decreases patient's safety or the oncological
treatment's effect. Hence, the feasibility and safety of SND by VATS remain controversial.
In many institutions, the indication for VATS major pulmonary resection is limited to
clinical stage I or II. For the application of the procedure to clinical stage IIIA, it
remains controversial. Recently, Watanabe et al. did a retrospective study aimed at
determining the outcome of patients with cN0-pN2 NSCLC who underwent VATS major pulmonary
resection with SND versus the outcome after major pulmonary resection with SND by open
thoracotomy. It demonstrated that VATS major pulmonary resection with SND was a feasible
approach to management of cN0-pN2 NSCLC without loss of curability. It was unnecessary to
convert the VATS approach to thoracotomy in order to do SND even if pN2 disease is revealed
during VATS major pulmonary resection. The purpose of this study is to know whether VATS
major pulmonary resection with SND for clinical stage IIIA non-small cell lung cancer is
possible.