Uncomplicated VATS lobectomies in early stage lung cancer; the Greek oxymoron of keeping up with the guidelines and achieving financial loss

<bold>Introduction:</bold> VATS lobectomy is the current mainstay of treatment in early-stage lung cancer (LC), related with improved clinical outcomes. Appropriate reimbursement is required to ensure service sustainability. <bold>Aim:</bold> To study the current reimbursement established by the Greek National Health System for VATS lobectomy and compare it against the expenditure. Materials&methods: Retrospective review of all patients who underwent VATS lobectomy for early-stage LC between 2020-2023. All medical records, expenditure and final reimbursements were reviewed. <bold>Results:</bold> 140 patients underwent VATS lobectomy for early-stage LC. 132/140 had an uncomplicated procedure (mean hospital stay 3 days), and 8 had a complicated procedure requiring conversion to open thoracotomy (mean stay 6.5 days). Reimbursement for uncomplicated VATS lobectomies is ~2,300EU and corresponds to 7-day hospital stay and 4,270EU for complicated cases corresponds to 12 days. The standard consumables’ cost(endoGIA stapler device including 3 vascular&3 tissue stapler cassettes) is ~2,100EU depending on types of cassettes. Each uncomplicated case uses up all the reimbursement on consumables without other costs. Should 140 cases were performed with open thoracotomy, the consumables’ costs would have been 35,000EU and their reimbursement 294,000EU with an 88% surplus without deducting other costs. <bold>Conclusions:</bold> The fundamental basis of reimbursement in the Greek National Health system favours open thoracotomies over minimal invasive techniques against current practice and guidelines. An urgent update is required to ensure financial sustainability of Greek thoracic surgery centres.