A successful shift from thoracotomy to video-assisted thoracoscopic lobectomy for non-small cell lung cancer in a low-volume center

Viktor Asbjornsson, Gyda Johannsdottir, Daniel Myer, Thorri Geir Runarsson, Leon Arnar Heitmann, Guðrún Nína Óskarsdóttir, Per Martin Silverborn, Henrik Jessen Hansen, Tómas Guðbjartsson

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Although video-assisted thoracoscopic surgery (VATS) lobectomy has become the gold standard for pulmonary resections of non-small-cell lung cancer (NSCLC), lobectomy is still performed via thoracotomy in many European and North American centres. VATS lobectomy was implemented overnight from thoracotomy in our low-volume centre in early 2019, after 1 senior surgeon undertook observership VATS-training overseas, and immediately became the mainstay of surgical treatment for NSCLC in Iceland. We aimed to investigate our short-term outcomes of VATS lobectomy.

METHODS: This was a retrospective study on all pulmonary resections for NSCLC in Iceland 2019-2022, especially focusing on VATS lobectomies, all at cTNM stage I or II. Data were retrieved from hospital charts, including information on perioperative complications, mortality, length of stay and operation time.

RESULTS: Out of 204 pulmonary resections, mostly performed by a single senior cardiothoracic surgeon, 169 were lobectomies (82.9%) with 147 out of 169 (87.0%) being VATS lobectomies. Anterolateral thoracotomy was used in 34 cases (16.7%), including 22 lobectomies (64.7%), and 5 (3.4%) conversions from VATS lobectomy. The median postoperative stay for VATS lobectomy was 4 days and the average operating time decreased from 155 to 124 min between the first and last year of the study (P < 0.001). The rate of major and minor complications was 2.7% and 15.6% respectively. One year survival was 95.6% and all patients survived 30 days postoperatively.

CONCLUSIONS: The implementation of VATS lobectomy has been successful in our small geographically isolated centre, serving a population of 390 000. Although technically challenging, VATS lobectomy was implemented fast for most NSCLC cases, with short-term outcomes that are comparable to larger high-volume centres.

Original languageEnglish
Article numberivae018
Pages (from-to)ivae018
Number of pages6
JournalInterdisciplinary cardiovascular and thoracic surgery
Issue number2
Early online date30 Jan 2024
Publication statusPublished - 2 Feb 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

Other keywords

  • 30-Day mortality
  • Conversion
  • Learning curve
  • Lobectomy
  • Non-small-cell lung cancer
  • Video-assisted thoracoscopic surgery


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