Prolonged air leaks after vats lobectomy: do we need another risk score?

Video-assisted thoracoscopic (VATS) lobectomy has become the standard surgical approach for the treatment of early-stage lung cancer. Equivalent oncological results and significant advantages in terms of postoperative pain control and reduced length of stay have been reported in comparison with open surgical approaches (1). One of the main issues that may limit the widespread use of mini-invasive techniques concerns the cost-effectiveness of this approach, and a reduction of postoperative hospital stay is essential to balance the higher operative costs of VATS procedures. Protocols for enhanced recovery after surgery (ERAS) have focused on this point, and some Authors have even described the possibility of a discharge from the hospital the day after surgery (2,3).