Lung cancer is the most common cause of death by malignancy, responsible for more deaths than the next 4 causes combined and predicted to account for nearly 220,000 new cancer diagnoses and 160,000 deaths in 2009.1 For patients with early-stage non–small cell lung cancer (NSCLC), lobectomy with mediastinal lymph node dissection is considered the optimal treatment.2 Segmentectomy, anatomic sublobar resection of one or more bronchopulmonary segments, has a role in the management of some patients with early-stage NSCLC.2,3
Thoracoscopic lobectomy has been successfully performed worldwide for more than a decade, has emerged as a reasonable option for the management of early-stage NSCLC,4,5 and is supported by evidence-based treatment guidelines.2 Advantages of thoracoscopic lobectomy compared with thoracotomy include less postoperative pain,6,7 better pulmonary function,7,8 shorter hospitalization,4–11 and improved delivery of adjuvant chemotherapy to eligible patients.12,13
Despite these outcomes, the advantages of thoracoscopic lobectomy seem to be underused. From 1999 to 2006, only 20% of all lobectomies for NSCLC were performed thoracoscopically by the board-certified thoracic surgeons participating in the general thoracic surgery component of The Society of Thoracic Surgeons (STS) database.14 Recent assessment of morbidity after thoracoscopic lobectomy showed superior results for many outcomes compared with thoracotomy.15–22 This article analyzes the various strategies of surgical resection for patients with early-stage NSCLC.
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