Combined Approach for NSCLC with Chest Wall Invasion: the Role of VATS

To date the conventional open surgery has been the standard surgical management of non-small cell lung cancer with chest wall invasion, which is seen in less than 10% of patients with lung cancer in mostly reported series. Minimally invasive techniques have emerged as alternative approaches for the treatment of locally advanced and more complex cases, with a demonstrated oncologic outcomes equivalent to open thoracotomy and lower overall complication and mortality rates. Despite, there are few published studies, the en-bloc chest wall resection with vertebrectomy can be perform by a video-thoracoscopic hybrid techniques in selected patients with lung cancer invading the spine. In this article, we describe our surgical approach and technical aspects of VATS hybrid approach for T4 vertebra combined resection. In addition, the different minimally invasive approaches described in the existing literature are briefly examined.