Stage IIIA non-small cell lung cancer: a contraindication for videoassisted thoracic surgery lobectomy?-a narrative review

Answering the question about contraindications for video -assisted thoracic surgery (VATS) in stage IIIA non -small cell lung cancer (NSCLC) is not simple, as stage IIIA relates to a heterogeneous group of bronchogenic carcinomas with locoregional involvement by extension of the primary tumor as well as ipsilateral nodal involvement posing a significant challenge in terms of surgical indication. VATS is imposing over open surgery as the standard of surgical care for early stage lung cancer, showing benefits in postoperative pain, recovery, morbidity and preservation of lung function while being equivalent in terms of oncologic outcome. To date the role of minimally invasive surgery in stage IIIA lung cancer has been reviewed only in few aspects: the practice of VATS in stage IIIA lung cancer has to be considered carefully in relation to the patient's clinical background taking also into account the surgical experience of the operating surgeons. Up to date, the choice of VATS in stage IIIA lung cancer seems to be feasible in selected cases with at least equivalent outcomes in comparison to open surgery. With the progression of the learning curve of the VATS technique as well as the development of dedicated instrumentation it is plausible that a larger number of cases of stage IIIA lung cancer will be treated through VATS in the near future. The aim of this review article is to describe feasibility, technical aspects and outcomes of VATS lobectomy in patients with stage IIIA NSCLC.