Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis

Abstract

Background: Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. Methods: This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. Results: Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5±200.1 vs. 233.3±318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6±5.7 vs. 10.1±5.1, P<0.001), less chest drainage volume (1,109.5±854.0 vs. 1,324.1±948.8, P<0.001), and less postoperative complications(4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1±9.4 vs. 13.7±7.7, P<0.001) and more positive lymph nodes being dissected (1.5±3.9 vs. 1.1±2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5±1.9 vs. 5.2±1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4±1.4 vs. 3.1±1.3, P<0.001).Conclusions: VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph

Perioperative Outcomes of Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy After Neoadjuvant Chemoimmunotherapy in Resectable NSCLC

“…However, the average number of total and N2 lymph nodes resected in the VATS group was both lower than in the open thoracotomy group. Retrospective multicenter studies ( 11 , 20 ) have reported that although there is a reduced average number of resected lymph nodes during VATS, long-term survival is still better than open thoracotomy. Zhang et al ( 21 ).…”

“…Furthermore, video-assisted thoracic surgery (VATS) is superior to open thoracotomy for the resection of early stage NSCLC, with the advantages of less complications, less pain, faster recovery and equivalent long-term survival ( 8 – 11 ); however, several recent case series and anecdotal reports have suggested that VATS following neoadjuvant chemotherapy could also achieve satisfactory outcomes in locally advanced NSCLC patients ( 2 , 12 – 14 ). But there was little evidence suggesting the feasibility and safety of VATS after neoadjuvant chemoimmunotherapy in NSCLC.…”

Propensity score-matched comparison of robotic- and video-assisted thoracoscopic surgery, and open lobectomy for non-small cell lung cancer patients aged 75 years or older

“…Patients who underwent RATS were associated with the shortest operation duration (RATS 100.85 ± 29.06 vs VATS 113.75 ± 33.40 vs OL 112.76 ± 22.85 mins, p <0.001) and the least blood loss (p <0.001). RATS also led to the shortest ICU stay (RATS 0[0-1] vs VATS 1[0-1] vs OL 1[0-1] days, p = 0.004), chest tube drainage duration (RATS 4 [3][4][5][6] vs VATS 5 [4][5][6] vs OL 5 [5][6][7] days, p <0.001) and postoperative stay (RATS 5 [4][5][6] vs VATS 5 [4][5][6][7] vs OL 6 [5][6][7][8] days, p <0.001) among three surgical approaches, and had a similar conversion rate compared with VATS (p = 0.184). However, the overall cost in the RATS group was $14838.26 ± 2841.65, which was significantly higher than that in the VATS ($13190.51 ± 2120.18, p <0.001) and OL ($13429.58 ± 2582.36, p <0.001) group.…”

“…Although open lobectomy (OL) is still the standard surgical approach for resectable NSCLC, it is associated with considerable postoperative complications and even surgeryrelated mortalities, especially in elderly patients (6). Thus, minimally invasive surgeries (MISs) which could reduce postoperative complications and shorten postoperative hospital stay, such as video-assisted thoracoscopic surgery (VATS), have been widely adopted (7). Numerous studies have suggested that VATS achieved better perioperative outcomes and similar longterm survival compared to OL for older NSCLC patients (8)(9)(10).…”

Effects of 24-hour postoperative intravenous fluid on postoperative outcomes after lobectomy: a retrospective observational study

“…Lobectomy with systematic mediastinal lymph node dissection is the gold standard surgical treatment for early non-small cell lung cancer (NSCLC) ( 1 ). Lobectomy performed by video-assisted thoracoscopic surgery (VATS) has been shown to reduce postoperative pain, inflammatory response, and length of hospital stay ( 2 ). Although the overall mortality from lobectomy has declined to approximately 0.5–1% with the improvement of surgical techniques and perioperative management ( 3 ), the morbidity after lobectomy for lung cancer remains between 26.0% and 54.7% ( 3 - 5 ).…”