Résections pulmonaires majeures par vidéothoracoscopie: un nouveau standard pour le traitement chirurgical des cancers primitifs de stades précoces ?

Video Assisted Thoracic Surgery (VATS) was initially limited to minor lung procedures such as wedge resection of peripheral nodules. Techniques developed for major resections (lobectomy-pneumonectomy) are numerous, heterogeneous, and sometimes include a minithoracotomy with rib spreading, making them lose their potential benefit on the early postoperative course, without alleviating some doubts as for their oncologic efficiency. With time, a consensus was made in favor of techniques having in common the absence of rib spreading, and the visualization of the operative field through the video monitor only. This so-called “full thoracoscopic” surgery expands slowly in Europe, conversely to what is observed in the United States and Japan. Nevertheless, 2 meta-analyses suggest a decrease in the postoperative morbidity in comparison with open surgery, as well as an oncologic non-inferiority. The feasibility of VATS segmentectomies offers an additional option in the management of the small-sized tumors (cT1a) and glass round opacities of the lung, the incidence of which is expected to increase with the expansion of chest-ct screening programs. In the incoming era of stereotactic radiosurgery and radiofrequency ablation, VATS competes to become the new standard for the treatment of early stage primary lung cancers.