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Practice Patterns in Anatomical Lung Resections:
The European Survey

Dear ESTS Colleague,

The landscape of thoracic surgery is rapidly evolving, with significant variation in surgical practices across institutions.

At present, there is no clear understanding of the preferred approaches and techniques adopted by thoracic surgeons for anatomical lung resections in the treatment of NSCLC across Europe.

This survey aims to provide a snapshot of current European practices. We have included questions covering various clinical scenarios to better reflect real-world decision-making.

The survey takes only a few minutes to complete.

Thank you for your time and contribution.

On behalf of the Authors,

Dr Marcin Ostrowski
ESTS Survey Coordinator
1.For authorship purposes only, please write your full name, email address and affiliation, as you would like it to appear in the manuscript (these details will be dealt with confidentiality).
Those who opt not to write their name will not be listed among the collaborators.
General Information
2.In what country do you work?(Required.)
3.What is your gender?(Required.)
4.Which of the following best describes your primary institution?(Required.)
5.What is your total number of years of experience in thoracic surgery?
(including both training and post-specialization practice)(Required.)
6.What is the estimated, annual number of the anatomical lung resections performed in your institution?(Required.)
7.What is the estimated, annual number of the anatomical lung resections performed by you as a main surgeon?(Required.)
8.Is video-assisted thoracoscopic surgery (VATS) routinely available in your institution?(Required.)
9.Is robotic-assisted thoracoscopic surgery (RATS) routinely available in your institution?(Required.)
10.Is preoperative 3D imaging reconstruction (e.g., CT-based) routinely used for anatomical lung resections in your institution?(Required.)
Surgical Approach and Technique Preferences
11.What is your preferred initial surgical approach in early-stage NSCLC for the following:
Thoracotomy
Uniportal VATS
Multiportal VATS
RATS
a straightforward lobectomy
a straightforward segmentectomy
12.In case of an incomplete fissure, if you need to perform a lobectomy, which approach do you prefer?(Required.)
13.In patients eligible for both VATS and RATS, which factors guide your choice? (multiple answers allowed)(Required.)
14.Do you use 3D imaging reconstruction when planning the following:(Required.)
Yes, routinely for all cases
Yes, only for cases I consider challenging based on standard CT imaging
I would like to use it, but it is not available at my institution
I would like to use it, but it is not reimbursed by health insurance in the country where I work
No, I do not use 3D imaging reconstruction
lobectomy
segmentectomy
15.What is your preferred device for hilar and mediastinal lymph node dissection?(Required.)
16.What is your preferred device for the following vessel sealing:(Required.)
Monopolar device
Ultrasonic device
Advanced bipolar device
Clipping device
Surgical stapler
Surgical ligation
a small vessel (<7 mm)
a large vessel (>7 mm)
17.What is your preferred initial surgical approach for the following cases(Required.)
thoracotomy
uniportal VATS
multiportal VATS
RATS
depends on radiological response/tumour characteristics
I do not perform such procedures
Lobectomy with chest wall resection in locally advanced NSCLC
Lobectomy after induction therapy in locally advanced NSCLC without suspected mediastinal nodal involvement
Lobectomy after induction therapy in locally advanced NSCLC with suspected mediastinal nodal involvement
18.Are you currently involved in any prospective trial or registry related to anatomical lung resections in NSCLC?
(multiple answers allowed)(Required.)
19.When performing anatomical lung resections, how would you rate your overall physical comfort with the following approaches?
(1-very uncomfortable, 2-uncomfortable, 3-neutral, 4-comfortable, 5-very comfortable)(Required.)
1
2
3
4
5
Thoracotomy
Uniportal VATS
Multiportal VATS
RATS
20.Would you consider ergonomics a relevant factor when choosing your surgical approach?(Required.)
Last Section: Preferences In An Ideal Clinical Setting

Please answer questions 21-23 assuming that both VATS and RATS are fully available at your institution
(i.e. no restrictions related to cost, access or reimbursement)
21.What would be your preferred initial surgical approach in early-stage NSCLC for the following:(Required.)
Uniportal VATS
Multiportal VATS
RATS
It would depend on patient- or tumour-specific factors
I am not sure
a straightforward lobectomy
a straightforward segmentectomy
22.What would be the main reason for your choice of approach?
(multiple answers allowed)(Required.)
23.Would this unrestricted scenario influence your current practice or training priorities?(Required.)
24.Have you got any additional remarks?
Many thanks for sharing your insights with us.
Results from this survey will be published and further discussed.

The Authors