COMPARATIVE CLINICAL EFFECTIVENESS OF THORACOTOMY AND VATS IN THORACIC SURGERY
Keywords:
thoracotomy, VATS, chest trauma, minimally invasive surgery, clinical effectiveness.Abstract
Background. The increasing incidence of chest trauma and the rapid development of minimally invasive technologies highlight the need for selecting optimal surgical strategies.
Objective. To evaluate the clinical effectiveness, safety, and postoperative outcomes of open thoracotomy and VATS.
Materials and Methods. A retrospective analysis of clinical data of patients treated between 2020 and 2026 was performed.
Results and Discussion. Open thoracotomy predominated in the surgical structure. Postoperative complications and mortality were more frequent in elderly patients. According to literature data, VATS is associated with lower surgical trauma, reduced complication rates, and faster patient recovery.
Conclusions. Open thoracotomy remains the method of choice in severe cases, whereas VATS represents a promising minimally invasive approach that should be more widely implemented in clinical practice.
References
1. Bendixen M, Jorgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy: a randomized controlled trial. Ann Thorac Surg. 2016;102(6):1973-1980. doi:10.1016/j.athoracsur.2016.06.031
2. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2016;101(2):408-412. doi:10.1016/j.athoracsur.2015.07.087
3. Whitson BA, Groth SS, Andrade RS, Maddaus MA. Survival after lobectomy for early-stage non-small cell lung cancer: thoracotomy vs VATS. J Thorac Cardiovasc Surg. 2017;153(3):S41-S48. doi:10.1016/j.jtcvs.2016.09.080
4. Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery. Eur Respir J. 2017;49(3):1600760. doi:10.1183/13993003.00760-2016
5. Scott WJ, Allen MS, Darling G, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of CALGB 140503. J Clin Oncol. 2018;36(7):701-708. doi:10.1200/JCO.2017.74.5973
6. Liu L, Mei J, He J. Comparison of VATS and thoracotomy for lung cancer: systematic review and meta-analysis. J Thorac Dis. 2018;10(5):2670-2678. doi:10.21037/jtd.2018.04.45
7. Dziedzic D, Orlowski T. The role of VATS in lung cancer surgery: current status and future directions. J Thorac Dis. 2018;10(Suppl 32):S3778-S3785. doi:10.21037/jtd.2018.09.41
8. Paul S, Altorki NK, Sheng S, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis. Ann Thorac Surg. 2014;97(1):236-242. doi:10.1016/j.athoracsur.2013.07.071
9. Cheng D, Downey RJ, Kernstine K, et al. Video-assisted thoracic surgery in lung cancer resection: systematic review. J Thorac Dis. 2017;9(8):2232-2240. doi:10.21037/jtd.2017.06.62
10. Gonzalez-Rivas D, Delgado M, Fieira E, Mendez L. Uniportal video-assisted thoracoscopic lobectomy. J Thorac Dis. 2016;8(Suppl 3):S229-S232. doi:10.21037/jtd.2016.03.12
11. Taioli E, Lee DS, Lesser M, et al. Long-term survival after VATS lobectomy vs thoracotomy: meta-analysis. Lancet Oncol. 2015;16(6):e273-e282. doi:10.1016/S1470-2045(15)70199-8
12. Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for lung cancer: systematic review. Eur J Cardiothorac Surg. 2015;47(3):588-598. doi:10.1093/ejcts/ezu197
13. Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized trials on VATS vs thoracotomy. Ann Surg. 2009;249(5):793-801. doi:10.1097/SLA.0b013e3181a38e13
14. Kirby TJ, Mack MJ, Landreneau RJ, et al. Lobectomy-video-assisted thoracic surgery versus muscle-sparing thoracotomy. Ann Thorac Surg. 2015;99(1):224-229. doi:10.1016/j.athoracsur.2014.08.058
15. Kent MS, Wang T, Whyte R, et al. Open versus thoracoscopic lobectomy outcomes. Ann Thorac Surg. 2014;97(1):236-242. doi:10.1016/j.athoracsur.2013.07.071
16. Lim E, Batchelor TJP, Dunning J, et al. Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer: UK VIOLET randomized clinical trial. J Clin Oncol. 2022;40(29):3472-3483. doi:10.1200/JCO.21.02529
17. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery (ERAS). Eur J Cardiothorac Surg. 2019;55(1):91-115. doi:10.1093/ejcts/ezy301
18. Ng CSH, Lau RWH, Wong RHY. Video-assisted thoracic surgery lobectomy for lung cancer: state of the art. J Thorac Dis. 2019;11(Suppl 8):S1210-S1217. doi:10.21037/jtd.2019.03.45
19. Harris CG, James RS, Tian DH, et al. Systematic review and meta-analysis of VATS vs thoracotomy outcomes. Ann Thorac Surg. 2020;110(5):1648-1656. doi:10.1016/j.athoracsur.2020.03.047
20. Subramanian M, McMurry TL, Meyers BF, et al. Long-term outcomes after VATS vs open lobectomy. Ann Thorac Surg. 2018;106(6):1629-1636. doi:10.1016/j.athoracsur.2018.06.050
21. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on surgical approach in lung cancer. J Thorac Cardiovasc Surg. 2017;153(3):764-773. doi:10.1016/j.jtcvs.2016.10.040
22. Cao J, Yuan P, Wang Y, et al. Survival outcomes after VATS vs open lobectomy: meta-analysis. Lung Cancer. 2019;130:90-97. doi:10.1016/j.lungcan.2019.02.007
23. Li WWL, van Boven WJ, Annema JT, et al. Management of lung cancer: role of minimally invasive surgery. Eur Respir Rev. 2016;25(141):152-164. doi:10.1183/16000617.0001-2016
24. Xie D, Wu J, Gonzalez-Rivas D, et al. Uniportal VATS versus multiportal VATS: meta-analysis. J Thorac Dis. 2020;12(3):915-927. doi:10.21037/jtd.2019.12.93
25. Handy JR Jr, Asaph JW, Douville EC, et al. Does video-assisted thoracoscopic lobectomy improve outcomes? Ann Thorac Surg. 2016;89(6):1865-1870. doi:10.1016/j.athoracsur.2016.02.054
26. Stephens N, Rice D, Correa AM, et al. Video-assisted thoracoscopic surgery versus thoracotomy for lung cancer: perioperative and long-term outcomes. Ann Thorac Surg. 2021;111(6):1956–1963. doi:10.1016/j.athoracsur.2020.09.061
