Changes and current status of lung cancer surgery at the National Cancer Center Hospital

Abstract

Surgical treatment for lung cancer at the National Cancer Center Hospital in Tokyo has evolved considerably over the past three decades. Early standard procedures required large thoracotomies with 30–40 cm incisions, often requiring rib resection. The introduction of video-assisted thoracic surgery (VATS) in the 1990s accelerated the adoption of minimally invasive approaches in Japan. However, concerns regarding intraoperative bleeding control, surgical precision, and training limited the use of complete VATS. To address these limitations, our team developed Hybrid VATS—also termed minimally invasive open surgery (MIOS)—as the institutional standard. This technique integrates thoracoscopic visualization with a 3–5 cm mini-thoracotomy, enabling secure vascular management, shorter operative times, extremely low morbidity and mortality, and adaptability for extended resections. It also provides notable educational advantages for resident education.

Recently, anatomical segmentectomy has increased substantially, representing >40% of lung cancer resections at our institution since 2021. This shift aligns with findings from randomized trials, including JCOG0802 and CALGB 140503, which demonstrated the non-inferiority and, in certain outcomes, superiority of segmentectomy compared with lobectomy for small peripheral lung cancers. We consider the principles of Hybrid VATS—balancing safety, curability, and minimal invasiveness—highly relevant to pediatric surgical oncology, where maintaining function and ensuring safety are critical. This report reviews the historical development of lung cancer surgery at our hospital, outlines the advantages of Hybrid VATS, and discusses its potential applications in pediatric oncology.