[Are video-assisted thoracoscopic resections in oncological surgery defensible?].

Video-assisted thoracoscopic surgery (VATS) is not to be accepted in oncologic patients at present. Up till now, the technical facilities are not as advanced as to compete with the established procedures of conventional surgery. The thoracoscopic, more indirect surgical methods are not able to adequately adjust to the specific growth pattern and paths of metastatic spread of bronchial carcinoma. Surgery for pulmonary metastasis has to be considered under the same aspects. Preoperative staging of lung cancer and the location and number of pulmonary metastases cannot be sufficiently assessed by computed tomography. Consequently, palpation of both the inflated and deflated lung is mandatory. Oncologic surgery includes complete lymph node dissection in all compartments, which cannot be achieved by VATS at present. It is irresponsible to risk the internationally quite homogenous stage-related results obtained in bronchial carcinoma for the sake of some new technical equipment. In surgery for lung metastasis, curative treatment demands to completely remove all lesions and the corresponding lymph nodes. This management alone promises benefit for the patient. VATS is established in 1) removal of coin lesions (change to open surgery in case of malignancy; 2) diagnostic resection in metastasis surgery. Results after VATS have to be assessed for quality control in VATS in the same way as it is done for open surgery.