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. 2010 Mar 22;4(1):1.
doi: 10.1186/1750-1164-4-1.

A comparison of perioperative outcomes of video-assisted thoracic surgical (VATS) lobectomy with open thoracotomy and lobectomy: results of an analysis using propensity score based weighting

Walter J Scott  1 , Ronald S Matteotti, Brian L Egleston, Salewa Oseni, James F Flaherty
Affiliations

A comparison of perioperative outcomes of video-assisted thoracic surgical (VATS) lobectomy with open thoracotomy and lobectomy: results of an analysis using propensity score based weighting

Walter J Scott et al. Ann Surg Innov Res. .

Abstract

Background: Randomized trials comparing VATS lobectomy to open lobectomy are of small size. We analyzed a case-control series using propensity score-weighting to adjust for important covariates in order to compare the clinical outcomes of the two techniques.

Methods: We compared patients undergoing lobectomy for clinical stage I lung cancer (NSCLC) by either VATS or open (THOR) methods. Inverse probability of treatment weighted estimators, with weights derived from propensity scores, were used to adjust cohorts for determinants of perioperative morbidity and mortality including age, gender, preop FEV1, ASA class, and Charlson Comorbidity Index (CCI). Bootstrap methods provided standard errors. Endpoints were postoperative stay (LOS), chest tube duration, complications, and lymph node retrieval.

Results: We analyzed 136 consecutive lobectomy patients. Operative mortality was 1/62 (1.6%) for THOR and 1/74 (1.4%) for VATS, P = 1.00. 5/74 (6.7%) VATS were converted to open procedures. Adjusted median LOS was 7 days (THOR) versus 4 days (VATS), P < 0.0001, HR = 0.33. Adjusted median chest tube duration (days) was 5 (THOR) versus 3 (VATS), P < 0.0001, HR = 0.42. Complication rates were 39% (THOR) versus 34% (VATS), P = 0.61. Adjusted mean number of lymph nodes dissected per patient was 18.1 (THOR) versus 14.8 (VATS), p = 0.17.

Conclusions: After balancing covariates that affect morbidity, mortality and LOS in this case-control series using propensity-weighting, the results confirm that VATS lobectomy is associated with a statistically significant shorter LOS, similar mortality and complication rates and similar rates of lymph node removal in patients with clinical stage I NSCLC.

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References

    1. Kirby TJ, Mack MJ, Landreneau RJ. Lobectomy-video-assisted thoracic surgery versus muscle-sparing thoracotomy: a randomized trial. J Thorac Cardiovasc Surg. 1995;109:997–1002. doi: 10.1016/S0022-5223(95)70326-8. - DOI - PubMed
    1. Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis inpatients with clinical stage IA lung cancer. World J Surg. 2000;24:27–31. doi: 10.1007/s002689910006. - DOI - PubMed
    1. Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;20:455–63. doi: 10.1016/S1010-7940(01)00841-7. - DOI - PubMed
    1. Shigemura N, Akashi A, Nakagiri T, Ohta M, Matsuda H. Complete vs. assisted thoracoscopic approach: a prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques. Surg Endosc. 2004;18:1492–7. doi: 10.1007/s00464-003-8252-4. - DOI - PubMed
    1. Swanson S. Video-Assisted Thoracic Surgery Lobectomy: Report of CALGB 39802--A Prospective, Multi-Institution Feasibility Study. J Clin Oncol. 2007;25:4993–4997. doi: 10.1200/JCO.2007.12.6649. - DOI - PubMed

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