Randomized controlled trials are needed to test videothoracoscopy versus thoracotomy for lung cancer lobectomy.

3rd Mediterranean Symposium on Thoracic Surgical Oncology, Catania, Italy, 21-22 April 2016 Surgeons presented their experience on videothoracoscopic lobectomy at the 3rd Mediterranean Symposium on Thoracic Surgical Oncology. The audience did not question that lobectomy could be done safely and as completely by videothoracoscopic techniques provided it was in expert and practiced hands and suitable patients. The question addressed here is whether video-assisted thoracic surgery can replace thoracotomy as a standard of care in patients suitable for either approach. To determine which provides the better outcome in terms of long-term survival with equivalent quality of life, would require direct comparison in pragmatic randomized controlled trials.