Video-Assisted Thoracic Surgery Lobectomy versus Lobectomy by Thoracotomy for Lung Cancer: Pilot Study

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Video-assisted thoracic surgery lobectomy (VATS-L) has become accepted as a safe and effective procedure to treat early-stage non–small cell lung carcinoma (NSCLC). However, the advantages of VATS-L compared with lobectomy by thoracotomy (TL) remain controversial. The aim of this study was to compare the outcomes of patients who underwent VATS-L with those who underwent TL. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We studied 103 patients who underwent surgery for operable NSCLC between October 2009 and March 2012. All operations were performed by a single surgeon. The inclusion and exclusion criteria for VATS-L and TL were formulated before the study was initiated. Data on age, sex, preoperative comorbidities, intraoperative and postoperative complications, hospital stay, morbidity, mortality, and other characteristics were recorded preoperatively, in real time intra-operatively, and during hospitalization and were statistically compared. Comorbidities were scaled according to the Charlson Comorbidity Index, and propensity scores between the patients who underwent TL and VATS-L were compared. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Sixty-three VATS-L operations and 40 TL operations were performed. There were no postoperative complications in 39 patients (61.9%) who underwent VATS-L compared with 25 patients (62.5%) who underwent TL. The patients who underwent TL were significantly younger than the patients who underwent VATS-L (mean ± SD, 64.7 ± 12.6 vs 70.9 ± 8.4; P = 0.003). Hospital stay was not found to be related to the type of surgery (mean ± SD, 8.43 ± 3.15 days vs 8.32 ± 4.13 days; P = 0.888). There were no significant differences when comparing postoperative complications. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Our initial data suggest that VATS-L is a safe procedure in patients with resectable IA/IB NSCLC and may be the preferred strategy for treatment of the older patient population. </jats:p></jats:sec>

Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy

“…Patients operated by VATS were older, and had a lower cancer stage, slightly lower Charlson comorbidity score, smaller tumours and a higher frequency of adenocarcinoma. These findings are in accordance with several studies [9,15,19,20]; however, confounding by indication cannot be disregarded due to these differences. The multi-institutionaland the national studies by Philips et al and Paul et al, respectively, did not include cancer stage [14,15].…”

“…In this large study, we found that patients operated by VATS had significantly lower prevalence of both minor and major complications, which included atrial fibrillation, pneumonia, renal failure, sepsis, costa fracture and need for intensive care unit, even after adjustment for other risk factors. Similar findings were reported in other studies [9,[14][15][16][17]. Our multivariate analysis showed that the surgery method had larger impact on the prevalence of complications than gender, age, cancer stage, comorbidity, year of surgery and FEV1.…”

“…Only a few small randomized trials have been conducted comparing VATS to OT and it is unlikely that more will be performed, due to the general acceptance of the safety and efficacy of VATS. VATS has been shown to be associated with fewer complications, shorter hospital stay and less surgical morbidity [7,8]; however, some studies found no difference between VATS and OT [9,10]. Consequently, our aim was to compare the 30-day morbidity and mortality of anatomic resection of primary lung cancer between VATS and OT.…”

Short term curative effect of video assisted thoracoscopic lobectomy for early-stage lung cancer

“…According to evidence-based medicine, there is no significant difference between curative effect of thoracoscopic lobectomy and thoracotomy lobectomy for stage I NSCLC. [6,[11][12][13][20][21][22] However, adopting VATS or thoracotomy for the treatment of early stage lung cancer has been controversial, and conflicting evidence exists in the form of large retrospective studies that failed to show any significant benefit from VATS. [23] Its adoption has been variable, likely due to perceived technical challenges when compared to an open approach and a concern for intraoperative complications, especially whether VATS is radical or not.…”

“…[6][7][8] Many published studies had demonstrated encouraging outcomes of this procedure when compared with conventional thoracotomy, including reduced incidence of arrhythmias, pneumonia, pain and lower levels of inflammatory markers, shorter length of hospital stay, milder pain, less intraoperative blood loss, more rapid return to normal activities, earlier ability to receive adjuvant therapy, and higher postoperative quality of life. [8][9][10][11][12][13][14] In 2006, minimally invasive surgical treatment of lung cancer was written in NSCLC clinical practice guidelines of National Comprehensive Cancer Network (NCCN). [15] The 2013 version of the NCCN guidelines recommended that VATS is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications, as long as there is no compromise of standard oncologic dissection principles of thoracic surgery.…”