Surgical Approaches for Early-Stage Lung Cancer

All procedures were performed under general anesthesia and single-lung ventilation, with the patient lying on the lateral decubitus. For all surgeries, the first operator was one of the two surgeons with the widest experience in open (at least 15 years) and U-VATS surgery in our team. Patients who had undergone surgery from January 2014 to May 2016 were operated on by thoracotomy. The U-VATS program started in our center in June 2016 and, since then, all patients affected by stage IA-IIB lung cancer were operated on by the U-VATS approach, progressively. Therefore, the open approach, still used for more central and big lesions in the first months of our U-VATS program, was subsequently abandoned for the treatment of early-stage lung cancer.
Open surgery was performed through a lateral muscle-sparing thoracotomy on the V intercostal space and usually, two chest tubes are left in place after surgery. U-VATS was carried out through a 4-cm single incision on the V intercostal space, with only one chest tube in the same incision, according to our standardized procedure (11 (link), 12 (link)) (Figure 2A).
Lymphadenectomy (LND) was performed according to the oncological standard of radical LND in both techniques: lobe-related nodal stations 10 and 11 and nodes in positions 7, 8, and 9, as well as in 2, 3, and 4 for the right side, and 5 and 6 for the left side (Figure 2B) were removed.