Video-assisted thoracoscopic surgery or open thoracotomy approach for surgery for non-small cell lung cancer—no definitive answer, yet

An assessment of postoperative pain has always been a problem in surgery on non-small cell lung cancer (NSCLC). First of all, there has never been any prospective randomized trial comparing a traditional posterolateral thoracotomy and a newer anterolateral approach, despite some theoretical considerations that the second one should be less painful. Currently, we face a similar problem with comparison between multiportal vs. uniportal video-assisted thoracoscopic surgery (VATS) lobectomy. The third issue is a comparison of the VATS and open thoracotomy approach for lobectomy for NSCLC addressed by Bendixen et al. (1). These authors deserve a special credit for publication of the first prospective randomized study in the Western literature devoted to this problem. Well-planned methodology is a strong side of the study. Proficiency of the participating surgeons both in the open and the VATS approach was especially valuable. Bendixen et al. proved that the VATS approach was associated with less postoperative pain and better quality of life than was an anterolateral thoracotomy for the first year after surgery and concluded that VATS should be the preferred surgical approach for lobectomy in stage I NSCLC