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Dolan et al. Mini-invasive Surg 2020;4:40 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.17

Review Open Access

Current state of minimally invasive treatment of
locally advanced non-small cell lung cancer

Daniel P. Dolan, Aaron R. Dezube, Scott J. Swanson
Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA 02115, USA.

Correspondence to: Dr. Daniel P. Dolan, Division of Thoracic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston,
MA 02115, USA. E-mail: ddolan7@bwh.harvard.edu

How to cite this article: Dolan DP, Dezube AR, Swanson SJ. Current state of minimally invasive treatment of locally advanced
non-small cell lung cancer. Mini-invasive Surg 2020;4:40. http://dx.doi.org/10.20517/2574-1225.2020.17
Received: 18 Jan 2020 First Decision: 2 Apr 2020 Revised: 2 Apr 2020 Accepted: 29 Apr 2020 Published: 30 Jun 2020

Science Editor: Noriyoshi Sawabata Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Locally advanced non-small cell lung cancer (NSCLC) has historically been defined as Stage III by the IASCLC
staging. While the workup for these patients has been standardized, the treatment algorithms remain unclear. The
use of neoadjuvant chemotherapy, radiotherapy, and now immunotherapy still awaits results in terms of optimal
regimen. Surgery for local disease control is routinely used and this group of patients have historically been treated
with open thoracotomy for resection. Only in the last 10-20 years have minimally invasive surgical methods been
applied for treatment. Video-assisted and robotic-assisted thoracoscopic surgery have retrospectively been shown
to be safe and effective with equivalent or better perioperative outcomes, long-term overall and disease-free
survival, mediastinal lymph node staging to open thoracotomy, and the ability to operate on patients who are too
sick for thoracotomy. This review shows that minimally invasive surgery for treatment of locally advanced NSCLC
disease should now be routinely offered to patients as the initial surgical method of resection.

Keywords: Locally advanced, minimally invasive surgery, video assisted thoracoscopic surgery, non-small cell lung
cancer

INTRODUCTION
Locally advanced non-small cell lung cancer (NSCLC) has been variably defined in the literature from
Stage III alone in the 7th edition International Association for the Study of Lung Cancer (IASCLC) staging
to the inclusion of the stage groupings of II, IIIA, IIIB, and the newly created IIIC in the 8th edition of
[1,2]
the IASCLC Tumor Node Metastasis (TNM) staging . This further breakdown in the 8th edition TNM
staging was reflective of the different prognosis for T3 and T4 tumor size associated with N3 nodal disease
without metastases. This change means Stage III in the 8th edition of the TNM staging range in size from

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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