# Long-Term Oncological Outcomes of Minimally Invasive Surgery in Non-Small Cell Lung Cancer: An Updated Review

## TL;DR

Minimally invasive surgery for non-small cell lung cancer offers similar long-term cancer outcomes as traditional open surgery, with faster recovery and less pain.

## Contribution

This review evaluates the long-term oncological outcomes of VATS and RATS in NSCLC, comparing them to open surgery and each other.

## Key findings

- VATS and RATS show comparable or better oncological outcomes than open surgery in early-stage NSCLC.
- RATS may offer a potential disease-free survival advantage over VATS based on some studies.
- Ongoing randomized trials are needed to confirm the long-term benefits of each minimally invasive technique.

## Abstract

Surgery is the cornerstone of curative treatment for early-stage lung cancer. In recent years, minimally invasive surgery (VATS and RATS) has gradually replaced open thoracotomy, reducing morbidity, hospital stays, decreasing pain and speeding up postoperative recovery while maintaining oncological efficacy. This review provides an overview of the current evidence on long-term oncological outcomes after minimally invasive surgery, including disease-free/recurrence-free survival and overall survival. Although evidence based mainly on retrospective studies shows that minimally invasive approaches achieve oncological results comparable to open surgery, ongoing randomized studies will help to understand the best therapeutic strategy for patients with resectable NSCLC.

Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancers, and surgical resection is the gold-standard treatment for resectable disease. Minimally invasive surgery (MIS), which includes video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), has emerged as an alternative option to thoracotomy, with the aim of minimizing perioperative morbidity without compromising oncological efficacy. This narrative review evaluates long-term oncological outcomes (overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS)) in patients with NSCLC at different stages who underwent MIS. Retrospective and prospective studies, as well as meta-analyses, are included. VATS has shown comparable and, in many cases, superior oncological outcomes compared to open surgery, with more evident benefits in the early stages of the disease. Although mainly in retrospective studies, RATS has demonstrated efficacy in terms of oncological outcomes comparable to open surgery, even in advanced stages or complex resections. With regard to the direct comparison between VATS and RATS, the two MIS techniques have shown similar OS rates, albeit some prospective data and meta-analyses suggest a potential DFS advantage for RATS. MIS is a safe and effective surgical approach in terms of oncological outcomes for resectable NSCLC; nevertheless, it will be necessary to await the results of further randomized studies currently ongoing to better define the long-term benefits of each technique.