Video-Assisted Thoracic Surgery (VATS) Lobectomy for Pathologic Stage I Non-Small Cell Lung Cancer: A Comparative Study with Thoracotomy Lobectomy

Abstract

BackgroundSurgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to evaluate the feasibility of VATS lobectomy for pathologic stage I NSCLC.Material and MethodsBetween December 2003 and December 2007, 529 patients with pathologic stage I NSCLC underwent lobectomies (373 thoracotomy, 156 VATS). Patients in both groups were selected after being matched by age, gender and pathologic stage using propensity score method, to create two comparable groups: thoracotomy and VATS groups, and the overall survival, recurrence-free survival, complication and length of hospitalization were compared between these two groups.ResultsAfter the patients were matched by age, gender and pathologic stage, 272 patients remained eligible for analysis, 136 in each group (mean age of 59.5 years; 70 men, 66 women; 80 stage IA, 56 stage IB). There was no statistical difference in other preoperative clinical characteristics between the two groups. No hospital mortality was observed in both groups. Overall 3-year survival rate was 97.4% in thoracotomy group and 96.6% in VATS groups (p=0.76). During the follow-up, 20 patients (14.7%) developed recurrence in thoracotomy group, including loco- regional recurrence in 7, distant metastasis in 13. In VATS group, 13 patients (9.6%) developed recurrence, including loco-regional recurrence in 4, distant metastasis in 9. Three-year recurrence-free survival rate was 81.8% in thoracotomy group and 85.3% in VATS groups (p=0.43). There was no significant difference in postoperative complications between thoracotomy and VATS groups (30 cases in 22 patients vs. 19 cases in 17 patients, p=0.65, odds ratio=1.19). The mean hospital stay of VATS group was 2 days shorter than that of thoracotomy group (8.8±6.5 days vs. 6.3±3.3 days, p<0.05).ConclusionVATS lobectomy for pathologic stage I lung cancer is a feasible operation with shorter hospitalization, while surgical outcome is comparable to thoracotomy lobectomy.

Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients

“…Consistent with our study, Yan et al [6] showed that VATS lobectomy decreased the acute postoperative pain, reduced inflammatory cytokine release, exhibited less impairment in pulmonary function, shorter chest tube duration and consequently shorter hospitalization days, in NSCLC patients. Interestingly, Park et al [17] presented evidence that the surgical outcomes in VATS lobectomy were comparable in success to TOS in NSCLC patients diagnosed early for the disease and VATS is a feasible operation associated with shorter hospitalization, which is generally preferred by patients. Jiang et al [7] also compared the two surgeries, within the context of adjuvant chemotherapy, and showed that VATS had fewer delays or dose reductions and better compliance than TOS.…”

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

“…The multi-institutionaland the national studies by Philips et al and Paul et al, respectively, did not include cancer stage [14,15]. Furthermore, many studies have been limited to Stage 1 lung cancer [16,17,19,21]. Cancer stage could be a predictor for intraoperative complications; a higher stage is often associated with a larger and more centrally placed tumour, making the risk of damaging the large vessels greater when dissecting the lobe.…”

First Italian Consensus Conference on VATS Lobectomy for NSCLC

“…Two years after the publication by Yan et al Korean researchers published a 1:1 propensity-matched study that considered 270 patients with stage I NSCLC (10). No statistical differences in postoperative complications were found between the 2 groups, but the VATS group had a significantly shorter hospital stay (p<0.05).…”