Role of video-assisted thoracic surgery in T4 NSCLC

Abstract

: For many years, T4 lung tumors have been considered less suitable for surgery, because of their local extension invading central structures or vertebral bodies. To date, many studies have confirmed the advantages in terms of survival of a multimodality approach made up of surgical resection associated with neoadjuvant and/or adjuvant therapy for selected patients with advanced lung cancer. In those patients, in fact, minimally invasive surgery could improve overall survival rates while promoting faster recovery, faster access to adjuvant therapies and preserving a better functionality of the immune system. Because of the difficulty in collecting data on patients with T4 lung tumors amenable to minimally invasive surgery, published evidences only come from case reports which prove the feasibility and the possible advantages of video-assisted thoracic surgery (VATS) procedures. The aim of this literature review is to collect the published experiences of skilled surgeons dealing with T4 tumors invading central structures or chest wall, to analyze concerns and new opportunities of treatment and proving the feasibility and advantages of the VATS approach.