However , intercostal nerve injury seems to be the most important pathogenic factor .
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25 - 60 % of patients .
Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre- , intra- , and postoperative factors .
This review attempts to analyse the methodology and systematic s of the studies on the  post-thoracotomy pain syndrome ( PTPS ) after lung cancer surgery in adults , in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention .
Lobectomy--video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial.
Video-assisted thoracic surgery has been adopted by some thoracic surgeons as the preferred approach over thoracotomy for many benign and malignant diseases of the chest . However , little concrete evidence exists to support this technique as the superior approach . This r and omized study was carried out to define the advantages of video-assisted lobectomy over muscle-sparing thoracotomy and lobectomy .  Sixty-one patients with presumed clinical stage I non-small-cell lung cancer were entered into the study . Each patient was r and omized to muscle-sparing thoracotomy and lobectomy or video-assisted lobectomy .  Six patients were excluded from the study either because final pathologic results revealed nonmalignant disease ( 3 patients ) or because an attempted video-assisted lobectomy was converted to a thoracotomy . This left 30 patients in the thoracotomy group and 25 patients in the video-assisted group . No significant differences existed between the two groups in operating time , intraoperative blood loss , duration of chest tube drainage , or length of hospital stay . Significantly more postoperative complications occurred in the thoracotomy group ( p < 0.5 ) , the majority of which were prolonged air leaks . Return to work time was not an issue because the majority of the patients were either retired or not working at the time of the operation . Only three patients had persistent postthoracotomy pain ( thoracotomy , n = 2 ; video-assisted lobectomy , n = 1 ) . We conclude that video-assisted lobectomy was not associated with a significant decrease in duration of chest tube drainage , length of hospital stay , postthoracotomy pain , or , in this group of patients , a faster recovery time and return to work .  Video-assisted lobectomy continues to expose the patient to the risk of a major pulmonary resection being done in an essentially closed chest . These results illustrate the need for critical evaluation of video-assisted thoracic surgery before the procedure is accepted as a superior approach based on presumed and thus far unproved advantages
However , intercostal nerve injury seems to be the most important pathogenic factor .
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25 - 60 % of patients .
Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre- , intra- , and postoperative factors .
This review attempts to analyse the methodology and systematic s of the studies on the  post-thoracotomy pain syndrome ( PTPS ) after lung cancer surgery in adults , in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention .