Comparison of survival between lung cancer patients receiving single or multiple-incision thoracoscopic surgery

Abstract

Background: The effect of single-incision thoracoscopic surgery for lung cancer on long-term survival is unknown and no studies have investigated whether there are differences in survival between single and multiple incision approaches. We aimed to compare long-term overall survival and disease-free survival of patients who underwent single-incision thoracoscopic surgery with those who received multiple-incision thoracoscopic surgery for lung cancer.

Methods: We retrospectively analyzed 532 patients with lung cancer who underwent either single-incision (n=150) or multiple-incision thoracoscopic resection (n=382) during the period January 2000 to December 2014. Patients were matched on propensity score at a 1:2 ratio to estimate the effect of treatment on long-term and disease-free survival. Overall survival and disease-free survival were assessed using the Kaplan-Meier method, the log-rank test and Cox proportional-hazards regression.

Results: Propensity matching resulted in 138 patients in the single-incision group and 276 patients in the multiple-incision group. The matched patients in the single-incision group had a significantly better 5-year overall survival than those in the multiple-incision group (P=0.027). Disease-free survival was similar between the two groups before and after matching. The number of chest wall incisions did not influence overall survival or disease-free survival.

Conclusions: The long-term outcomes of single-incision thoracoscopic surgery are comparable to those of multiple-incision thoracoscopic surgery for lung cancer.

Keywords: Survival; lung cancer; multiple-incision; single-incision; thoracoscopic surgery.

Figure 1

Kaplan-Meier overall survival curves stratified by incision numbers in (A) all 532 un-matched patients, (B) pathologic stage I un-matched patients, (C) pathologic stage II un-matched patients, (D) pathologic stage III un-matched patients.

Figure 2

Kaplan-Meier disease-free survival curves stratified by incision numbers in (A) all 532 un-matched patients, (B) pathologic stage I un-matched patients, (C) pathologic stage II un-matched patients, (D) pathologic stage III un-matched patients.

Figure 3

Kaplan-Meier overall survival curves stratified by incision numbers in (A) all 414 matched patients, (B) pathologic stage I matched patients, (C) pathologic stage II matched patients, (D) pathologic stage III matched patients.

Figure 4

Kaplan-Meier disease-free survival curves stratified by incision numbers in (A) all 414 matched patients, (B) pathologic stage I matched patients, (C) pathologic stage II matched patients, (D) pathologic stage III matched patients.