From Technique to Decision: Patient Selection and Learning Curves as Determinants of Tailored VATS in NSCLC

Background: For resectable non-small-cell lung cancer, one of the leading causes of cancer-related mortality, surgical resection remains the best treatment. The increased commonality of minimally invasive approaches is due to their equivalence to open surgery in terms of oncological outcomes and results, despite their offer of the benefits of minimally invasive surgery. Methods: A literature search was conducted using PubMed, Web of Science, Google Scholar and Cochrane Library using the following keywords: VATS, uniportal-VATS, multiportal-VATS, minimally invasive surgery, NSCLC, Segmentectomy, Lobectomy, learning curve, perioperative outcomes, Clinical outcome from 1991 to 30 June 2026. Observational studies, multicenter studies, meta-analysis, systematic reviews and randomized controlled trials were included. Results: Compared to thoracotomy, it has been found that postoperative pain, complication rates and the length of hospital stay can be reduced by minimally invasive approaches without compromising surgical efficacy. The shift towards the single-port techniques further enhances these benefits by minimizing surgical trauma while ensuring the safety and feasibility of the procedure for increasingly complex lung resections. Tailoring is organized along three axes: the extent of resection, patient characteristics and team maturity. Conclusions: Current evidence synthesized in this narrative review suggests that minimally invasive surgery combined with ERAS protocols for anatomical lung resections can further optimize short-term outcomes without compromising the radicality or oncological efficacy of the treatment. The choice of technique is not absolute, but rather the result of a decision based on the individual patient, the surgeon’s experience, and the center’s resources.