WCLC 2025 - Posters & ePosters-EP.08.05 Minimally Invasive Approaches for Pancoast Tumor Resection: A Comparative Analysis of Surgical Techniques and Outcomes

EP.08.05 Minimally Invasive Approaches for Pancoast Tumor Resection: A Comparative Analysis of Surgical Techniques and Outcomes

Back to course

Pdf Summary

This retrospective multi-center study (2018–2024) compared traditional open thoracotomy and minimally invasive surgical techniques for resection of Pancoast tumors—apical lung cancers involving critical structures such as subclavian vessels and brachial plexus. The study utilized data from the Mie Thoracic Surgery Database covering nine cases: six underwent conventional high posterolateral thoracotomy, while three underwent minimally invasive approaches, including robot-assisted thoracic surgery (RATS) and uniportal video-assisted thoracic surgery (U-VATS) with lateral incisions.<br /><br />Open thoracotomy involved extensive chest wall muscle dissection and chest wall reconstruction, leading to significant postoperative complications such as nerve palsies, Horner’s syndrome, and pleural effusions—with a 50% rate of permanent disability. These approaches also caused notable chest wall trauma adversely affecting postoperative pain, respiratory function, and cosmetic outcomes.<br /><br />In contrast, the minimally invasive group showed longer operative times (average 405.7 vs. 370.3 minutes) but reduced blood loss (518 vs. 660.8 ml) and less chest wall destruction. Among the minimally invasive techniques, U-VATS demonstrated no permanent disabilities and fewer major complications compared to RATS and the open approach. Permanent disability rates were 33% overall for minimally invasive methods and 0% specifically for U-VATS.<br /><br />A detailed case of a 65-year-old female patient exemplified successful use of U-VATS for left upper division segmentectomy and chest wall resection with rib removal, tailored for her reduced pulmonary reserve, highlighting the method’s safety and efficacy.<br /><br />The study concludes that minimally invasive surgical approaches for Pancoast tumor resection are at least non-inferior to conventional open surgery, offering the benefits of less trauma, reduced blood loss, fewer postoperative complications, and lower rates of permanent disability, potentially improving outcomes especially in patients with compromised pulmonary function.

Asset Subtitle

Fumiaki Watanabe

Meta Tag

Speaker Fumiaki Watanabe

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

Pancoast tumors

open thoracotomy

minimally invasive surgery

robot-assisted thoracic surgery (RATS)

uniportal video-assisted thoracic surgery (U-VATS)

chest wall reconstruction

postoperative complications

permanent disability

operative time

blood loss