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Locally advanced non-small cell lung cancer (NSCLC) has historically been defined as Stage III by the IASCLC staging. While the workup for these patients has been standardized, the treatment algorithms remain unclear. The use of neoadjuvant chemotherapy, radiotherapy, and now immunotherapy still awaits results in terms of optimal regimen. Surgery for local disease control is routinely used and this group of patients have historically been treated with open thoracotomy for resection. Only in the last 10-20 years have minimally invasive surgical methods been applied for treatment. Video-assisted and robotic-assisted thoracoscopic surgery have retrospectively been shown to be safe and effective with equivalent or better perioperative outcomes, long-term overall and disease-free survival, mediastinal lymph node staging to open thoracotomy, and the ability to operate on patients who are too sick for thoracotomy. This review shows that minimally invasive surgery for treatment of locally advanced NSCLC disease should now be routinely offered to patients as the initial surgical method of resection.

Current state of minimally invasive treatment of locally advanced non-small cell lung cancer