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Minimally invasive thoracic surgery for early stage non-small cell lung cancer

BMJ 2014; 349 doi: (Published 02 October 2014) Cite this as: BMJ 2014;349:g5849
  1. Peter Ellis, medical oncologist
  1. 1Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, ON, Canada
  1. Correspondence to: peter.ellis{at}

A safe alternative to open surgery for experienced surgeons in high volume hospitals

Surgery for early stage non-small cell lung cancer remains the cornerstone of treatment. It allows complete resection of the tumor, accurate staging of the mediastinum, and more appropriate decision making about postoperative adjuvant chemotherapy. Open thoracotomy for lung cancer resections, however, carries associated risks of morbidity and mortality. Technological advances, such as video assisted thoracoscopic surgical techniques, offer the promise of reduced morbidity and improved surgical outcomes in comparison with open procedures.1

Data from randomized clinical trials evaluating this are lacking, however. One small randomized trial evaluated open versus thoracoscopic mediastinal lymph node dissection in stage I non-small cell lung cancer.2 No differences were observed in the number of lymph nodes retrieved. However, bias inherent in the design of existing published observational reports leaves uncertainty about the comparative effectiveness and safety of thoracoscopic versus open lobectomy.

The linked paper by Paul and colleagues (doi:10.1136/bmj.g5575) goes some way towards reducing this uncertainty.3 The authors used data on Medicare recipients included in the US Surveillance Epidemiology and End Results (SEER) database to …

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