Current status of video-assisted thoracoscopic surgery lobectomy in nodal positive non-small cell lung cancer

Video-assisted thoracoscopic surgery (VATS) lobectomy has been proven to be effective in the treatment of early stage non-small cell lung cancer (NSCLC). Compared to the thoracotomy approach, patients tend to have less pain, fewer postoperative complications and shorter hospital length of stays. Oncologically, there is no survival difference compared to the open approach. VATS lobectomy is now being applied to locally advanced disease, including larger tumors, clinically nodal positive disease and patients who underwent induction therapy. We review four aspects of VATS lobectomy and how it can be applied to patients with nodal positive disease. This includes nodal clearance and pathologic upstaging, the learning curved associated with VATS lobectomy, robotic-assisted VATS lobectomy, and VATS in patients who have received induction therapy.