Is video-assisted lobectomy for non-small-cell lung cancer oncologically equivalent to open lobectomy?

Abstract

Objectives: The purpose of this study was to compare overall and disease-free survival after VATS and open lobectomy for clinical Stage I and II non-small-cell lung cancer (NSCLC).

Methods: A retrospective review of a prospective database of all patients undergoing VATS or open lobectomy for clinical Stage I or II NSCLC between 2002 and 2010 was performed. Postoperative outcomes, disease-free survival and overall survival were compared between the two groups after optimum 1:1 propensity matching for age, gender, tumour histology and pathological stage.

Results: Over an 8-year period, 608 patients underwent lobectomy for NCSLC by VATS (n = 196, 32%) or open technique (n = 412, 68%). After matching, there were 190 patients in each group. Adenocarcinoma was found in 80% (open: 149, VATS: 152) and 55% of tumours were T1 (open: 108, VATS: 105). Pathological N1 disease was found in 21 and 19 patients in the open and VATS group, respectively. Disease-free 5-year survival was 69.1% for the open group vs 69.7% for VATS (P = 0.94). Cancer-specific 5-year survival was 82.9% for the open group vs 76.7% for VATS (P = 0.170). Five-year overall survival was 73% in the open group vs 64% in the VATS group (P = 0.17). Operative mortality and postoperative complications were not significantly different between groups.

Conclusions: Overall survival and disease-free survival are not significantly different when compared between VATS lobectomy and open lobectomy. VATS resection appears to provide an adequate oncological operation for patients with operable clinical Stage I and II NSCLC.

Keywords: Lobectomy; Nodal staging; Non-small-cell lung cancer; Propensity matching; Video-assisted thoracic surgery.