{"doi":"10.1016/j.xjon.2021.07.038","title":"Minimally invasive lung resection after induction therapy: Is there evidence?","abstract":"Central MessageThere is growing evidence that minimally invasive surgical approaches for resection of locally advanced lung cancer after induction therapy are feasible and can achieve acceptable oncologic results. There is growing evidence that minimally invasive surgical approaches for resection of locally advanced lung cancer after induction therapy are feasible and can achieve acceptable oncologic results. Feature Editor Note—Minimally invasive lobectomy should arguably be considered the standard surgical approach to stage I non–small cell lung cancer. There is strong evidence to support this assertion. For more than a decade now, surgeons have recognized that the benefits of thoracoscopic and robotic lobectomy could be extended to patients with locally advanced tumors, including those undergoing induction therapies. Importantly, in the current era of immunotherapy and molecular targeted therapy, thoracic surgical practices have become enriched for these patients. Whereas evidence supporting minimally invasive lobectomy after induction therapy is accumulating, it is not as robust as that which is available for early-stage disease. In this Feature Expert Opinion article, available evidence for minimally invasive lobectomy after induction therapy is contextualized by an author whose experience in this field has largely guided its direction. The reader will find a balanced interpretation of this body of literature that that will promote their safe adoption of minimally invasive lobectomy for locally advanced non–small cell lung cancer.Bryan M. Burt, MD Minimally invasive surgical (MIS) techniques (video-assisted thoracoscopic surgery [VATS] and robotic) for the primary treatment of early-stage lung cancer are known to be feasible and effective. Moreover, compared with the historical standard (thoracotomy), MIS approaches have advantages, including reduced complication rates, shorter length of hospitalization, decreased early postoperative pain, and quicker recovery. In the initial published experiences with both VATS and robotics, patients with locally advanced disease (larger tumors, invasion of adjacent structures, hilar and mediastinal nodal metastases) were generally excluded. In particular, receipt of induction therapy was a relative contraindication to approaching resection by MIS. However, as experience and technology have evolved, it has become evident that VATS and robotics are being increasingly used in patients who have undergone induction therapy. The questions are whether there is evidence to support this trend and what considerations are necessary for successful implementation. Unfortunately, there are precious few randomized, prospective trials comparing MIS with thoracotomy for the treatment of lung cancer, and with respect to the role of MIS after induction therapy there are virtually none. Currently, one of the largest randomized trials comparing VATS with open lobectomy for lung cancer is the ongoing Video-assisted thoracoscopic lobectomy versus conventional open lobectomy for lung cancer (the VIOLET study).1Lim E. Batchelor T. Shackcloth M. Dunning J. McGonigle N. Brush T. et al.Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomized controlled trial with an internal pilot (the VIOLET study).BMJ Open. 2019; 9: e029507Crossref PubMed Scopus (15) Google Scholar It will compare the effectiveness, cost-effectiveness, and acceptability of VATS versus open lobectomy for lung cancer with the primary outcome being self-reported physical functioning 5 weeks after randomization and among the secondary outcomes the oncologic outcomes. Unfortunately, this study will not include patients undergoing induction therapy but nonetheless will be an important addition to the literature. There are several high-quality, retrospective series both cohort and case–control studies that have shed light on feasibility and oncologic efficacy of MIS follow","journal":"JTCVS Open","year":2021,"id":226184,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9586,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":417848,"name":"Bernard J. Park","orcid":"0000-0003-3814-5144","position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":null,"created_at":"2026-07-18T23:54:34.185847Z","pmid":"36004063","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}