Video-assisted thoracoscopic anatomic lung resections in Germany-a nationwide survey.

Abstract

Video-assisted thoracoscopic surgery (VATS) is an accepted alternative to thoracotomy for anatomic lung resection (AR) and literature suggests benefits over the conventional open approach. However, it's routine clinical application is still low and varies within different countries. Nationwide survey among thoracic surgical units in Germany, evaluating the departmental structure, volume of the VATS program, experience with VATS-AR (lobectomies and other-than-lobectomies-anatomic-resections), surgical technique and learning curve data. Response rate among the 269 surgical units practicing thoracic surgery in Germany was 84.4% (n=227). One hundred twenty-two (53.7%) units do have experience with any type of VATS-AR. The majority of units started the VATS program only within the last 5years and 17.2% (n=21) of the units have performed more than 100 procedures by now. In 2013, 78.7% of the units performed less than 25% of their institutional AR via a VATS approach. Indications for VATS-AR were non-small cell lung cancer in 93.4% (up to UICC-stage IA, IB, IIA, IIB, IIIA in 7%, 22.8%, 33.3%, 17.5%, 7%, respectively), benign diseases in 57.4%, and pulmonary metastases in 50.8%. 43.4% of the departments had experience with extended VATS-AR and 28.7% performed VATS-AR after induction-therapy. Every second thoracic surgical unit in Germany does have experience in VATS-AR though only about 20% of them perform it routinely and also in extended procedures.