VATS lobectomy vs. open lobectomy for early-stage lung cancer: an endless question—are we close to a definite answer?

Initially described in 1992 (1), thoracoscopic (VATS) lobectomy is unquestionably the greatest upheaval in thoracic surgery community since the introduction of one-lung ventilation by Carlens in 1949 (2).In the last twenty years, after several initial uncertainty about its adoption, VATS lobectomy slowly but constantly propagates worldwide and, nowadays, most international guidelines suggest the adoption of this minimally invasive approach for early-stage lung cancer, over the traditional “open” approaches (3,4). Indeed, several single- and multi-institutional studies, as well as national registry analysis, showed that VATS lobectomy adoption permits a shorter chest tube duration, a shorter length of hospital stay, fewer postoperative complications, and a lower or comparable perioperative mortality vs. classic thoracotomy (5-13). Moreover, the recent results of UK multicentric VIOLET randomized controlled trial corroborated these statements, demonstrating an association between VATS lobectomy and enhanced short-term clinical outcomes when compared with open surgery for non-small cell lung cancer (NSCLC) (14,15).