Improving lung cancer surgery outcomes in low-resource countries: the role of video-assisted thoracoscopic surgery

Abstract Background Lung cancer surgery in low- and middle-income countries (LMICs) is frequently challenged by late-stage presentation, high comorbidity burden, and limited healthcare resources. Although video-assisted thoracoscopic surgery (VATS) is widely adopted in high-income settings, evidence regarding its feasibility, oncologic adequacy, and economic impact in resource-constrained environments remains limited. This study evaluated real-world perioperative and oncologic outcomes of VATS lobectomy in an LMIC setting. Methods This retrospective observational study included 400 consecutive adult patients undergoing anatomical lobectomy or bilobectomy for primary lung cancer at two tertiary thoracic surgery centers between 2019 and 2024. Preoperative evaluation included clinical assessment, pulmonary function testing, and cross-sectional imaging, with positron emission tomography used when available. Operative variables, postoperative complications (graded using the Clavien-Dindo system), length of hospital stay, and institutional procedural costs were recorded. Oncologic quality indicators included resection margin status, mediastinal lymph node dissection, nodal yield, and nodal upstaging rates. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier analysis. Results The cohort demonstrated a high prevalence of cardiopulmonary comorbidity and predominantly stage II–III disease. Conversion to thoracotomy occurred in 1.5% of cases. Complete (R0) resection was achieved in 98.5% of patients. Systematic mediastinal lymph node dissection yielded a mean of 12.4 nodes across a median of four stations. Nodal upstaging from clinically node-negative disease occurred in 11.5% of patients. Perioperative outcomes were favorable, with low intraoperative blood loss, short chest tube duration, and brief hospital stay. Postoperative complications occurred in 20% of patients with low early mortality. Estimated overall survival exceeded 90% at 24 months and remained above 80% at approximately 40 months. Conclusions In a real-world LMIC setting, VATS lobectomy is feasible, safe, oncologically adequate, and economically comparable to open surgery. These findings support the structured integration of minimally invasive thoracic surgery into lung cancer treatment pathways in resource-constrained healthcare systems.