Searching for an arrow hitting two targets: the time to evaluate long-term outcomes of video-assisted thoracoscopic surgery lobectomy for early-stage lung cancer

Tomohito Saito, Tomohiro Murakawa


Lung cancer is the leading cause of cancer deaths worldwide. Surgery has been a key element of definitive therapy for lung cancer since the first successful en-bloc left-sided pneumonectomy by Graham in 1933 (1). The evolution of lung cancer surgery has been driven by thoracic surgeons’ enthusiasm to achieve maximal oncological outcomes with minimal invasiveness; these two factors are essential in establishing the optimal surgical approach for lung cancer. In the 1950s and 1960s, lobectomy eventually replaced pneumonectomy for its safety and curative efficacy (2). The landmark Lung Cancer Study Group-821 study, the only completed randomized trial to date comparing lobectomy with sublobar resection, strongly supported thoracotomy lobectomy over thoracotomy sublobar resection for better oncological outcomes (3). For the past 60 years, lobectomy via thoracotomy with hilar and mediastinal lymph node dissection or sampling has been the standard of care for early stage (I or II) lung cancer.