Role of video-assisted thoracoscopic surgery and classic thoracotomy in lung cancer management.

Lung cancer is the leading cause of cancer-related death worldwide. For patients diagnosed with early-stage lung cancer, complete surgical resection remains the best hope for cure. Limited resections are avoided when possible because of higher recurrence rates and potentially worse long-term survival. Traditionally, a posterolateral thoracotomy has been used to perform anatomic lung resections and mediastinal lymph node dissection for complete staging. More recently, the use of video-assisted thoracoscopic surgery has been introduced for the treatment of stage I lung cancers. Although thought minimally invasive and thus perceived as resulting in less postoperative pain and faster recovery, its acceptance has varied worldwide. Questions about training, cost containment, and oncologic principles prevail. In essence, the absolute indications and limitations of video-assisted thoracoscopic surgery for patients with lung cancer have yet to be defined.