The experience of video-assisted thoracoscopic lobectomies

INTRODUCTION. Video-assisted thoracoscopic surgery (VATS) lobectomy is increasingly replacing open thoracotomy as the standard surgical treatment for early-stage non-small cell lung cancer owing to its greater efficacy, as demonstrated in RCTs. This study aimed to examine the effectiveness and evolution of lung cancer treatment by VATS lobectomy in a single centre. METHODS. This retrospective single-centre cohort study at the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark, examined operative reports for all VATS lobectomies performed in-house from 3 March 2008 to 6 July 2023, as well as medical records at one-year follow-up for 10% of the patients. RESULTS. VATS lobectomies were identified (N = 1,705). A steady annual increase in performed procedures and the number of performing surgeons was observed, and more frail patients underwent the procedure. Operation time, mean chest tube drainage time, length of hospitalisation and rate of annual conversions declined along with the amount and severity of postoperative complications, cancer recurrence and mortality at the one-year follow-up. CONCLUSIONS. Treatment effectiveness, measured by peri-and post-operative outcomes, aligned with the efficiency presented in RCTs, with significant benefits of VATS compared to traditional anterolateral thoracotomy. Furthermore, treatment effectiveness evolved during the study period, and the introduction and training of new surgeons improved, enhancing the quality and availability of VATS throughout the period.