Surgical approach matters for long-term lung cancer outcomes
A partir d'une revue systématique de la littérature publiée entre janvier 2000 et juin 2025 (557 articles, 1 185 patients), cette méta-analyse évalue l'efficacité, du point de vue de la survie globale et de la survie sans récidive, d'une lobectomie assistée par vidéo par rapport à une chirurgie ouverte pour un cancer du poumon de stade précoce
For more than a decade, the medical community has sought to ascertain the oncological effect of perioperative management during cancer surgery. Despite encouraging preclinical study results showing that the choice of drugs used during or after surgery and the degree of invasiveness of the surgery could increase the risk of tumour recurrence, no clinical trials have succeeded in translating these results into clinical practice. This is particularly true for thoracic surgery, a specialty that has witnessed major advances in lung cancer management over recent years with the development of minimally invasive surgical techniques (eg, video-assisted, robotic, uniportal, and monoportal approaches), enhanced post-surgical rehabilitation programmes, and multimodal treatments including neoadjuvant immunotherapy.
In The Lancet, Rosie A Harris and colleagues provide high-level evidence that the surgical approach to lung cancer resection can influence long-term survival. The authors conducted a meta-analysis of individual patient data from three prospective randomised controlled trials5–7 that were initially designed to assess the potential advantages of video-assisted thoracic surgery (VATS) over open thoracotomy in terms of postoperative pain, recovery, and quality of life after lung cancer surgery. The statistical methods were robust and well described, mitigating the inherent bias related to meta-analysis and managing patients lost to follow-up. Patients who underwent surgical resection of stage 1–2 lung cancer through VATS (n=586) or through open thoracotomy (n=599) were included. Patients in the VATS group had a significant improvement in overall survival compared with the open thoracotomy group, with a pooled hazard ratio of 0·79 (95% CI 0·65–0·96; ie, a 21% reduction in the risk of death). No significant difference was observed in disease-free survival; however, this result should be interpreted with caution, given that data on relapse were updated for only two of the three pooled trials, potentially underestimating late oncological events.
The Lancet , commentaire en libre accès, 2026