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Preoperative function evaluation of the major lung resection: muscle-sparing axillary mini-thoracotomy versus video-assisted thoracoscopic surgery

Background: In surgically fit non-small cell lung cancer (NSCLC) patients, pulmonary lobectomy still represents the standard of care. In recent years, the development of minimally invasive video-assisted techniques has reduced perioperative surgical stress, including patients previously thought to be unfit for surgery. Methods: We carried out a review of literature in order to evaluate the role of the preoperative parameters in functionally compromised patients and the effectiveness of video-assisted thoracoscopic surgery (VATS) compared to the “muscle sparing” axillary mini-thoracotomy in major lung resections. Results: Of 99 analyzed papers, we considered the 24 most significant, according to the preoperative functional status evaluation and, especially cardiac and respiratory reserve. 
 Conclusions: In patients with a reduced cardio-respiratory function undergoing pulmonary resection, VATS guarantees results superimposable to mini-thoracotomy and represents a valid alternative to be taken into consideration.