Regional lung chemotherapy techniques to enable or enhance minimally invasive lung surgery

Great strides occurred in the application of minimally invasive techniques for pulmonary lobectomy for almost all indications including advanced neoplasms. Novel treatments besides systemic chemotherapy might be useful to shrink large tumors to enable video-assisted thoracoscopic surgery (VATS) or to enhance treatments for patients with disseminated or otherwise unresectable disease. Several such regional treatments are under investigation and they include inhaled chemotherapy, direct tumor injection, chemoembolization, bronchial artery infusion (BAI), and pulmonary suffusion. These all have specific advantages and limitations depending on the tumor anatomy, physiology and location. Alternatively, VATS theoretically reduces morbidity for oligometastatic disease regional therapy patients who formerly required thoracotomy for vascular access. Promising experimental work with in-vivo pulmonary perfusion patterned on successful methods learned from lung allograft resuscitation is underway. Some of these strategies (alone or combined with standard therapy) are reproducible with existing clinical expertise and should be tested further in clinical trials. This in order to continue the progress toward reducing the morbidity of local control in patients with advanced malignancy, particularly those who are frail.