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Multicenter Study
. 2019 Jul;158(1):252-264.e2.
doi: 10.1016/j.jtcvs.2018.12.001. Epub 2018 Dec 18.

The role of thoracoscopic pneumonectomy in the management of non-small cell lung cancer: A multicenter study

Chi-Fu Jeffrey Yang  1 , Sai Yendamuri  2 , Nicholas R Mayne  1 , Athar Battoo  2 , Hanghang Wang  1 , R Ryan Meyerhoff  1 , Keith Vandusen  1 , Sameer A Hirji  3 , Mark F Berry  4 , Robert J McKenna Jr  5 , Todd L Demmy  2 , Thomas A D'Amico  6
Affiliations
Multicenter Study

The role of thoracoscopic pneumonectomy in the management of non-small cell lung cancer: A multicenter study

Chi-Fu Jeffrey Yang et al. J Thorac Cardiovasc Surg. 2019 Jul.

Erratum in

  • Notice of Correction.
    [No authors listed] [No authors listed] J Thorac Cardiovasc Surg. 2020 Feb;159(2):749. doi: 10.1016/j.jtcvs.2019.11.040. Epub 2019 Dec 4. J Thorac Cardiovasc Surg. 2020. PMID: 31812303 No abstract available.

Abstract

Objective: The objective of this study was to evaluate the impact of the video-assisted thoracoscopic (VATS) approach on the outcomes of patients who underwent pneumonectomy.

Methods: The effect of the surgical approach on perioperative complications and survival in patients who underwent pneumonectomy for nonmetastatic non-small cell lung cancer across 3 institutions (2000-2016) was assessed using multivariable logistic regression, Cox proportional hazards analysis, and propensity-score matching. Completion pneumonectomies were excluded from this study, and an "intent-to-treat" analysis was performed.

Results: During the study period, 359 patients met inclusion criteria and underwent pneumonectomy for nonmetastatic non-small cell lung cancer; 124 (35%) underwent pneumonectomy via VATS and 235 (65%) via thoracotomy. Perioperative mortality (VATS, 7% [n = 9] vs open, 8% [n = 19]; P = .75) and morbidity (VATS, 28% [n = 35] vs open, 28% [n = 65]; P = .91) were similar between the groups, even after multivariable adjustment. VATS showed similar 5-year survival when compared with thoracotomy in unadjusted analysis (47% [95% confidence interval (CI), 36-56] vs 33% [95% CI, 27-40]; P = .19), even after multivariable adjustment (hazard ratio, 0.76 [95% CI, 0.50-1.18]; P = .23). In a propensity score-matched analysis that balanced patient characteristics, there were no significant differences found in overall survival between the 2 groups (P = .69).

Conclusions: Although the role of VATS pneumonectomy will likely become clearer as more surgeons report results, this multicenter study suggests that the VATS approach for pneumonectomy can be performed safely, with at least equivalent oncologic outcomes when compared with thoracotomy.

Keywords: lung cancer; minimally invasive surgery; thoracic surgery.

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Figures

Figure 1:
Figure 1:
Overall and recurrence-free survival for patients undergoing VATS vs open pneumonectomy for non-small-cell lung cancer. (A) Overall survival. This figure depicts the Kaplan–Meier overall survival estimates of the open (solid line) versus VATS group (dashed line). (B) Recurrence-free survival. This figure depicts the Kaplan–Meier recurrence-free survival estimates of the open (solid line) versus VATS group (dashed line). Tick marks represent censored subjects.
Figure 1:
Figure 1:
Overall and recurrence-free survival for patients undergoing VATS vs open pneumonectomy for non-small-cell lung cancer. (A) Overall survival. This figure depicts the Kaplan–Meier overall survival estimates of the open (solid line) versus VATS group (dashed line). (B) Recurrence-free survival. This figure depicts the Kaplan–Meier recurrence-free survival estimates of the open (solid line) versus VATS group (dashed line). Tick marks represent censored subjects.
Figure 2:
Figure 2:
Overall and recurrence-free survival for patients undergoing VATS vs open pneumonectomy for non-small-cell lung cancer: propensity score-matched analysis. (A) Overall survival. This figure depicts the Kaplan–Meier overall survival estimates of the open (solid line) versus VATS group (dashed line) for patients included in the propensity score-matched analysis. (B) Recurrence-free survival. This figure depicts the Kaplan–Meier recurrence-free survival estimates of the open (solid line) versus VATS group (dashed line) for patients included in the propensity score-matched analysis. Tick marks represent censored subjects.
Figure 2:
Figure 2:
Overall and recurrence-free survival for patients undergoing VATS vs open pneumonectomy for non-small-cell lung cancer: propensity score-matched analysis. (A) Overall survival. This figure depicts the Kaplan–Meier overall survival estimates of the open (solid line) versus VATS group (dashed line) for patients included in the propensity score-matched analysis. (B) Recurrence-free survival. This figure depicts the Kaplan–Meier recurrence-free survival estimates of the open (solid line) versus VATS group (dashed line) for patients included in the propensity score-matched analysis. Tick marks represent censored subjects.
Central Picture
Central Picture
Overall survival for patients undergoing VATS vs open pneumonectomy for non-small-cell lung cancer.
See this image and copyright information in PMC

Comment in

References

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