Benefits and Radiological Preference Criteria of Hybrid-Video-Assisted Thoracic Surgery in the Treatment of Pancoast Tumor. A Comparative Study with Open Approaches.

Background: We tried to demonstrate the use and benefits of hybrid-video-assisted thoracic surgery (VATS) in Pancoast tumors by comparing it with open surgical approaches. Methods: Between January 2022 and January 2024, 29 patients operated for Pancoast tumor were retrospectively evaluated. Hybrid-VATS approach was used in 14 cases, while open surgery was used in 15 cases. The two groups were compared regarding demographic characteristics, preoperative and postoperative findings. Preoperative thoracic computed tomography findings were analyzed by an experienced radiologist to guide the choice of surgical approach. Results: The hybrid-VATS technique was statistically significantly superior to the thoracotomy group in terms of operative time and preoperative bleeding amount (P: .027, .012, respectively). There were statistically significantly fewer postoperative complications in the hybrid-VATS group (66.6% versus 21.4%, P:. 04). In preoperative thorax CT evaluation, the longest distance (>77 mm) at which the tumor invaded the chest wall was found to be statistically predictive in the choice of surgical approach (odds ratio: 7.3, P:. 01). Conclusions: Hybrid-VATS can be used in Pancoast tumor surgery in experienced centers with shorter operation time, less preoperative bleeding, and low postoperative complication rates compared with open surgery without compromising oncological principles. Preoperative thoracic CT may guide the choice of surgical approach.