Advanced VATS resections: radiation therapy and VATS

A history of radiation therapy can increase the technical complexity of a major lung resection. Outcomes when major lung resection is performed after radiation have improved over time, but previous radiation remains a risk factor for complications after surgery. Despite the increased risks, major lung resection may be indicated in specific oncologic situations after radiation. Experience with major lung resection after thoracotomy has been published in multiple studies, and the risks and difficulties in this situation are generally well understood. The literature regarding outcomes when video-assisted thoracic surgery (VATS) is used after radiation is much more sparse, but the studies that have been published suggest that approach is safe and feasible for select patients in surgeons with extensive VATS experience. This manuscript will review the role and risks of major lung resection after previous radiation via both thoracotomy and VATS, as well as specific considerations and techniques that may be appropriate when performing VATS after radiation therapy.