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Video-Assisted Thoracic Surgery for Lung Cancer Resection: A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2007

Downey, Robert J.*; Cheng, Davy†; Kernstine, Kemp‡; Stanbridge, Rex§; Shennib, Hani¶; Wolf, Randall∥; Ohtsuka, Toshiya**; Schmid, Ralph††; Waller, David‡‡; Fernando, Hiran§§; Yim, Anthony¶¶; Martin, Janet†∥∥

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: November 2007 - Volume 2 - Issue 6 - pp 293-302
doi: 10.1097/IMI.0b013e3181662c7f
Consensus Statement

Objective: The purpose of this consensus conference was to determine whether video-assisted thoracic surgery (VATS) improves clinical and resource outcomes compared with conventional thoracotomy (OPEN) in adults undergoing lobectomy for lung cancer, and to outline evidence-based recommendations for the use of VATS in performing lobectomy for lung cancer.

Methods: Before the consensus conference, the best available evidence was reviewed in that systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. At the consensus conference, evidence-based statements were created, and consensus processes were used to determine the ensuing recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of recommendation.

Results and Recommendations: The consensus panel agreed upon the following statements and recommendations in patients with clinical stage I nonsmall cell lung cancer undergoing lung lobectomy:

1. VATS can be recommended to reduce overall postoperative complications (class IIa, level A evidence).

2. VATS can be recommended to reduce pain and overall functionality over the short term (class IIa, level B evidence).

3. VATS can be recommended to improve delivery of adjuvant chemotherapy delivery (class IIa, level B evidence).

4. VATS can be recommended for lobectomy in clinical stage I and II non-small cell lung cancer patients, with no proven difference in stage-specific 5-year survival compared with open thoracotomy (class IIb, level B evidence).

From the *Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; †Department of Anesthesia and Perioperative Medicine, Evidence-Based Perioperative Clinical Outcomes Research Group (EPiCOR), London Health Sciences Centre, The University of Western Ontario, London, Ontario, Canada; ‡Department of Thoracic Surgery, Lung Cancer and Thoracic Oncology Program City of Hope National Medical Center and Beckman Research Institute, Duarte, California; §Department of Cardiothoracic Surgery, St. Mary Hospital Imperial NHS Trust, London, United Kingdom; ¶Department of Cardiothoracic Surgery, Brunswick Medical Center, Montreal, Quebec, Canada; ∥Department of Cardiovascular Surgery, University of Cincinnati, Cincinnati, Ohio; **Department of Cardiovascular Surgery, Tokyo Metropolitan Fuchu General Hospital, Tokyo, Japan; ††Klinik und Poliklinik für Thoraxchirurgie, Universitätsspital Bern, Bern, Schweiz; ‡‡Department of Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom; §§Department of Cardiothoracic Surgery, BMC, Boston, Massachusetts; ¶¶Minimally Invasive Centre, Union Hospital, Hong Kong, Peoples Republic of China; ∥∥High Impact Technology Evaluation Centre, London Health Sciences Centre, University Hospital, London, Ontario, Canada.

Support for the meta-analysis and a consensus conference was provided by, The International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS), which has received unrestricted educational grants from industries that produce surgical technologies.

Address correspondence and reprint requests to Dr. Robert Downey, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021; e-mail: downeyr@mskcc.org

© 2007 Lippincott Williams & Wilkins, Inc.