Current Status of Minimally Invasive Surgical Approaches for Early Stage Non-Small Cell Lung Cancer: Systematic Review

Volume 9, Issue 1, February 2024     |     PP. 76-88      |     PDF (210 K)    |     Pub. Date: September 22, 2020
DOI:    197 Downloads     1449 Views  


Mark Jaradeh, Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center 2160 S First Avenue, Maywood, IL, 60153, USA.
Brett Curran, Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center 2160 S First Avenue, Maywood, IL, 60153, USA.
Wickii T. Vigneswaran, Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center 2160 S First Avenue, Maywood, IL, 60153, USA.

Resection is the principal mode of treatment for early stage non-small cell lung cancer and the only treatment that is potentially curative. As such, surgical approach can be a crucial factor in successful treatment. Over the past three decades, the surgical modalities within thoracic surgery have undergone massive changes, mainly through the introduction of minimally invasive surgical techniques, such as video-assisted thoracic surgery and robot-assisted thoracic surgery, into the field. The advent of minimally invasive surgical techniques ushered in several advantages over open thoracotomy in the forms of reduced post-operative length of stay, surgical morbidity, functional recovery, and pain. Despite these advantages, opponents of these techniques were weary of their effectiveness in measures such as number of lymph nodes resected, disease-free survivability, cost, and procedure duration. As these techniques developed and evolved, their acceptance has greatly increased as literature suggests no reductions in oncologic effectiveness, nodal upstaging, disease-free survivability, or overall survivability. More recently, interest has been growing in robot-assisted thoracic surgery as some groups have published results indicating several preferences for the robot-assisted approach over the video-assisted approach when considering outcomes such as morbidity, blood loss, length of stay, and lymph node dissection. In this review, we attempt to explore the current literature surrounding these techniques in hopes of elucidating more about their differences based on recent studies.

Lung cancer, Pulmonary Adenocarcinoma, Squamous Cell Carcinoma, Lung resection, Robotic surgery

Cite this paper
Mark Jaradeh, Brett Curran, Wickii T. Vigneswaran, Current Status of Minimally Invasive Surgical Approaches for Early Stage Non-Small Cell Lung Cancer: Systematic Review , SCIREA Journal of Clinical Medicine. Volume 9, Issue 1, February 2024 | PP. 76-88.


[ 1 ] Louie BE, Wilson JL, Kim S, et al. Comparison of Video-Assisted Thoracoscopic Surgery and Robotic Approaches for Clinical Stage I and Stage II Non-Small Cell Lung Cancer Using The Society of Thoracic Surgeons Database. Ann Thorac Surg. 2016;102(3):917-924.
[ 2 ] Melfi FMA, Menconi GF, Mariani AM, Angeletti CA. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2002;21(5):864-868.
[ 3 ] Wei S, Chen M, Chen N, Liu L. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis. World J Surg Oncol. 2017;15(1):98.
[ 4 ] Cao C, Manganas C, Ang SC, Yan TD. A systematic review and meta-analysis on pulmonary resections by robotic video-assisted thoracic surgery. Ann Cardiothorac Surg. 2012;1(1):3-10.
[ 5 ] Ricciardi S, Davini F, Zirafa CC, Melfi F. From “open” to robotic assisted thoracic surgery: why RATS and not VATS? J Vis Surg. 2018;4:107-107.
[ 6 ] Kent M, Wang T, Whyte R, Curran T, Flores R, Gangadharan S. Open, Video-Assisted Thoracic Surgery, and Robotic Lobectomy: Review of a National Database. Ann Thorac Surg. 2014;97(1):236-244.
[ 7 ] Paul S, Sedrakyan A, Chiu Y, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg. 2013;43(4):813-817.
[ 8 ] Lee BE, Korst RJ, Kletsman E, Rutledge JR. Transitioning from video-assisted thoracic surgical lobectomy to robotics for lung cancer: Are there outcomes advantages? J Thorac Cardiovasc Surg. 2014;147(2):724-729.
[ 9 ] Toker A, Özyurtkan MO, Demirhan Ö, Ayalp K, Kaba E, Uyumaz E. Lymph Node Dissection in Surgery for Lung Cancer: Comparison of Open vs. Video-Assisted vs. Robotic-Assisted Approaches. Ann Thorac Cardiovasc Surg. 2016;22(5):284-290.
[ 10 ] Mungo B, Hooker CM, Ho JSY, et al. Robotic Versus Thoracoscopic Resection for Lung Cancer: Early Results of a New Robotic Program. J Laparoendosc Adv Surg Tech. 2016;26(4):243-248.
[ 11 ] Nishimura JM, Goodwin M, Kneuertz P, Moffatt-Bruce S, Merritt RE, D’Souza DM. Robotic lobectomy costs and quality of life. Mini-Invasive Surg. 2020;2020.
[ 12 ] Emmert A, Straube C, Buentzel J, Roever C. Robotic versus thoracoscopic lung resection: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(35):e7633.
[ 13 ] Denlinger CE, Fernandez F, Meyers BF, et al. Lymph Node Evaluation in Video-Assisted Thoracoscopic Lobectomy Versus Lobectomy by Thoracotomy. Ann Thorac Surg. 2010;89(6):1730–1736.
[ 14 ] Wang W, Yin W, Shao W, et al. Comparative study of systematic thoracoscopic lymphadenectomy and conventional thoracotomy in resectable non-small cell lung cancer. J Thorac Dis. 2014;6(1):45–51.
[ 15 ] Sato Y, Tezuka Y, Kanai Y, et al. Novel Retractor for Lymph Node Dissection by Video-Assisted Thoracic Surgery. Ann Thorac Surg. 2008;86(3):1036–1037.
[ 16 ] Ramos R, Girard P, Masuet C, Validire P, Gossot D. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: Totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg. 2012;41(6):1342–1348.
[ 17 ] Merritt RE, Hoang CD, Shrager JB. Lymph Node Evaluation Achieved by Open Lobectomy Compared With Thoracoscopic Lobectomy for N0 Lung Cancer. Ann Thorac Surg. 2013;96(4):1171–1177.
[ 18 ] Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg. 2011;142(4):740–746.
[ 19 ] Deen SA, Wilson JL, Wilshire CL, et al. Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches. Ann Thorac Surg. 2014;97(3):1000-1007.
[ 20 ] Demir A, Ayalp K, Ozkan B, Kaba E, Toker A. Robotic and video-assisted thoracic surgery lung segmentectomy for malignant and benign lesions†. Interact Cardiovasc Thorac Surg. 2015;20(3):304-309.
[ 21 ] Taniguchi Y, Nakamura H, Miwa K, et al. Initial Results of Robotic Surgery for Primary Lung Cancer: Feasibility, Safety and Learning Curve: Initial results of RATS for lung cancer. Yonago Acta Med. 2017;60(3):162-166.
[ 22 ] Novellis P, Bottoni E, Voulaz E, et al. Robotic surgery, video-assisted thoracic surgery, and open surgery for early stage lung cancer: comparison of costs and outcomes at a single institute. J Thorac Dis. 2018;10(2):790-798.
[ 23 ] Zhou Q, Huang J, Pan F, et al. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage IA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res. 2020;9(2):306-315.
[ 24 ] Louie BE, Farivar AS, Aye RW, Vallières E. Early Experience With Robotic Lung Resection Results in Similar Operative Outcomes and Morbidity When Compared With Matched Video-Assisted Thoracoscopic Surgery Cases. Ann Thorac Surg. 2012;93(5):1598–1605.
[ 25 ] Li C, Hu Y, Huang J, et al. Comparison of robotic-assisted lobectomy with video-assisted thoracic surgery for stage IIB–IIIA non-small cell lung cancer. Transl Lung Cancer Res. 2019;8(6):820–828.
[ 26 ] Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revision of the TNM Stage Groupings in the Forthcoming (Seventh) Edition of the TNM Classification of Malignant Tumours. J Thorac Oncol. 2007;2(8):706–714.
[ 27 ] Al-Kattan K. Disease recurrence after resection for stage I lung cancer. Eur J Cardiothorac Surg. 1997;12(3):380–384.
[ 28 ] Hoffman PC, Mauer AM, Vokes EE. Lung cancer. Lancet Lond Engl. 2000;355(9202):479–485.
[ 29 ] Carnio S, Novello S, Papotti M, Loiacono M, Scagliotti GV. Prognostic and predictive biomarkers in early stage non-small cell lung cancer: Tumor based approaches including gene signatures. Transl Lung Cancer Res. 2013;2(5):372–381.
[ 30 ] Park BJ, Melfi F, Mussi A, et al. Robotic lobectomy for Non–Small cell lung cancer (NSCLC): Long-Term oncologic results. J Thorac Cardiovasc Surg. 2012;143(2):383–389.
[ 31 ] Yang H-X, Woo KM, Sima CS, et al. Long-term Survival Based on the Surgical Approach to Lobectomy For Clinical Stage I Nonsmall Cell Lung Cancer: Comparison of Robotic, Video-Assisted Thoracic Surgery, and Thoracotomy Lobectomy. Ann Surg. 2017;265(2):431–437.
[ 32 ] Cerfolio RJ. Pulmonary Resection in the 21st Century. Tex Heart Inst J. 2012;39(6):848–849.
[ 33 ] Turchetti G, Palla I, Pierotti F, Cuschieri A. Economic evaluation of da Vinci-Assisted robotic surgery: A systematic review. Surg Endosc. 2012;26(3):598–606.
[ 34 ] Wei B, D’Amico TA. Thoracoscopic Versus Robotic Approaches. Thorac Surg Clin. 2014;24(2):177–188.
[ 35 ] Swanson SJ, Miller DL, McKenna RJ, et al. Comparing robot-assisted thoracic surgical lobectomy with conventional video-assisted thoracic surgical lobectomy and wedge resection: Results from a multihospital database (Premier). J Thorac Cardiovasc Surg. 2014;147(3):929-937.