Definition of an advanced lung cancer and associated survival after video-assisted thoracoscopic surgery resection

The definition of “advanced lung cancer” is unclear, especially considering surgical treatment. For a surgeon, who prefers video-assisted thoracoscopic surgery (VATS) approach, identification of specific problems, which make the VATS resection much more difficult, is quite understandable. But such variations in the definition make any productive comparing or collecting data very complicated, and incomparable with the traditional thoracic oncology studies. Randomized controlled trials for VATS for the locally advanced non-small cell lung cancer (NSCLC) have not been conducted yet. However, there are several relatively large series with the cohort of patients with advanced stages, treated by VATS. These publications are analyzed in this review. Many articles address the feasibility of VATS resections for challenging cases, such as sleeve broncho- and angioplasty, chest wall resection, Pancoast tumor, SVC resection, carina resection et cetera. But advanced or challenging surgery does not always signify the advanced stage of the cancer. One of the theoretical goals of minimally invasive surgery (MIS) is to reduce immunosuppression after the procedure. Thus, patients with the advanced stages could benefit from VATS due to a better preservation of the patient’s immunity and potential to optimize long-term survival. It seems to be necessary to organize a multi-institutional trial with strict inclusion criteria for patients with the stage III lung cancer, who underwent VATS major pulmonary resections, in order to generate sufficient and reliable analytical data for this topic.