The Uncomfortable Truth: Open Thoracotomy versus Minimally Invasive Surgery in Lung Cancer: A Systematic Review and Meta-Analysis

Simple Summary Surgery is the preferred treatment of choice for early-stage lung cancer, but historically, it required large incisions (open surgery) for access and removal of the tumor. Latest guidelines recommend minimally invasive surgery (MIS) as a preferred option for lung cancer due to better clinical outcomes. However, there is insufficient RCT (randomized clinical trial) evidence to establish the superiority of MIS over open surgery. This study revealed selection bias and problems related to surgical approach, with no significant difference in major postoperative complications between thoracotomy and MIS. Therefore, it is reasonable to allow experienced surgeons to choose the appropriate surgical approach for each patient. For decades, lung surgery in thoracic cancer has evolved in two ways: saving more parenchyma and being minimally invasive. Saving parenchyma is a fundamental principle of surgery. However, minimally invasive surgery (MIS) is a matter of approach, so it has to do with advances in surgical techniques and tools. For example, MIS has become possible with the introduction of VATS (video-assisted thoracic surgery), and the development of tools has extended the indication of MIS. Especially, RATS (robot-assisted thoracic surgery) improved the quality of life for patients and the ergonomics of doctors. However, the dichotomous idea that the MIS is new and right but the open thoracotomy is old and useless may be inappropriate. In fact, MIS is exactly the same as a classic thoracotomy in that it removes the mass/parenchyma containing cancer and mediastinal lymph nodes. Therefore, in this study, we compare randomized-controlled trials about open thoracotomy and MIS to find out which surgical method is more helpful.