Video-assisted thoracoscopic lobectomy versus open lobectomy in the treatment of large lung cancer: propensity-score matched analysis

Abstract

Background There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. This study aimed to compare perioperative outcomes and oncological validity between video-assisted thoracoscopic surgery (VATS) and open lobectomy for non-small cell lung cancer (NSCLC) with tumor size > 5 cm. Methods We retrospectively reviewed 355 patients who underwent lobectomy with clinical N0 NSCLC with solid tumor component diameter > 5 cm between January 2009 and December 2016. Patients with tumor invading adjacent structures were excluded. The patients were divided into the VATS group (n = 132) and thoracotomy group (n = 223). Propensity score matching (1:1) was applied. Results After propensity score matching, 204 patients were matched, and clinical characteristics of the two groups were well balanced. The VATS group was associated with a shorter length of hospital stay (6 days vs. 7 days; P < 0.001) than the thoracotomy group. There were no significant differences in the 5-year overall survival (71.5% in VATS vs. 64.4% in thoracotomy, P = 0.390) and 5-year recurrence-free survival (60.1% in VATS vs. 51.5% in thoracotomy, P = 0.210) between the two groups. The cumulative incidence of ipsilateral pleural recurrence was not significantly different between the two groups (12.0% in VATS vs. 7.9% in thoracotomy; P = 0.582). Conclusions In clinical N0 NSCLC larger than 5 cm, VATS lobectomy resulted in shorter hospital stay and similar survival outcome compared to open lobectomy. Based on these results, VATS lobectomy is a valuable option in this subset of patients.

Long‐term changes in psoas muscle mass after lobectomy and segmentectomy for early‐stage lung cancer

“…Similar to our study, Karasaki et al previously reported that cVATS preserved the reduction of the latissimus dorsi mass more than open thoracotomy at 1 year after surgery: 43% reduction of the latissimus dorsi mass with open thoracotomy and 11% with cVATS on the surgical side 29 . cVATS has been reported to be a technique that maintains fewer respiratory complications, shorter hospital stay, lower mortality, less pain and better postoperative QOL than open chest surgery without compromising oncological outcomes 30–33 . Charloux et al reported that the postoperative loss of FEV1 was 9% for segmentectomy through an open thoracotomy and 5% for segmentectomy through cVATS 8 .…”

Shortness of Breath on Day 1 After Surgery Alerting the Presence of Early Respiratory Complications After Surgery in Lung Cancer Patients

“…First, few lung cancer patients underwent open surgery, resulting in a lower frequency of PPCs, which may preclude the observation of a large group in a timely manner and affect the comparability and generalization of the study results. However, VATs have been increasingly applied for LC surgery during the past 10 57 and recent report showed the proportion of VATs was reached 74.9% in LC patients, 58 suggesting that this result can be interpreted for current clinical practice. Second, we used an anchor-based method to find the optimal cutpoint considering the relation between symptom severity and PPCs.…”

Dark side of the moon: the price to pay in minimally invasive thoracic surgery (MITS)

“…The reader is forced to consult other types of papers in which the operational times in minutes is reported. The muchheralded advantage regarding VATS in-hospital days is counterweighted by the time, in which the patient spends on the operational table in the theater (97). In-hospital stays are loosely related to the actual surgical technicality, connected to other non-operative or even extramedical factors and are famously multifactorial, and ultimately bias sensitive.…”