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VATS (video assisted thoracic surgery)

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Joseph B. Shrager, MD
Last Modified: January 13, 2002

Dear OncoLink "Ask The Experts,"

Could you give me some information on VATS (video assisted thoracic surgery) and its use opinion for Stage I lung cancer?  

Joseph B. Shrager, MD, Assistant Professor of Surgery and Director of General Thoracic Surgery at the University of Pennsylvania School of Medicine, responds:

The use of VATS (video assisted thoracic surgery) is controversial in the thoracic surgical community. Although some centers are regularly offering VATS lobectomies for the treatment of early stage lung cancer, this may not be extensive enough surgery for many patients. Even a small, suspected stage I tumor by CT scan has up to a 20% incidence of nodal metastases and it may not be possible to do a complete nodal dissection by VATS. This could jeopardize both the patients' chance of cure from surgery and appropriate recommendations for further treatment with chemotherapy or radiation therapy. If a clinical stage 1 tumor has been biopsied and is a squamous cell carcinoma, then the rate of nodal metastasis is probably less than 10% and it may be reasonable to elect for VATS lobectomy. However, I personally do not recommend this procedure for my patients.