Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Jiandong Mei; Chenglin Guo; Liang Xia; Hu Liao; Qiang Pu; Lin Ma; Chengwu Liu; Yunke Zhu; Feng Lin; Zhenyu Yang; Kejia Zhao; Guowei Che; Lunxu Liu

doi:10.21037/tlcr.2018.12.04

Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stage I-II non-small cell lung cancer are more favorable than thoracotomy: a propensity score-matched analysis from a high-volume center in China

Transl Lung Cancer Res. 2019 Apr;8(2):155-166. doi: 10.21037/tlcr.2018.12.04.

Authors

Jiandong Mei^{1

2}, Chenglin Guo^{1

2}, Liang Xia^{1

2}, Hu Liao^{1

2}, Qiang Pu^{1

2}, Lin Ma^{1

2}, Chengwu Liu^{1

2}, Yunke Zhu^{1

2}, Feng Lin^{1

2}, Zhenyu Yang^{1

2}, Kejia Zhao^{1

2}, Guowei Che^{1

2}, Lunxu Liu^{1

2}

Affiliations

¹ Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
² Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.

Abstract

Background: Video-assisted thoracic surgery (VATS) has been considered as the better choice for the surgical treatment of resectable non-small cell lung cancer (NSCLC). This study aimed to evaluate the short- and long-term outcomes of VATS versus open thoracotomy lobectomy for patients with pathological stage (p-stage) I-II NSCLC in one of the high-volume center in China.

Methods: Perioperative outcomes and long-term survival of patients who underwent VATS versus open lobectomies for p-stage I-II NSCLC from May 2006 to June 2013 in the Western China Lung Cancer Database (WCLCD) were studied using propensity score matching (PSM). The VATS lobectomy was mainly carried out using the single-direction technique.

Results: Of the 3,678 patients who underwent surgery for lung malignancies, 1,485 patients with stage I-II NSCLC were enrolled for the study, including 737 cases of VATS lobectomies and 748 cases of open lobectomies. PSM resulted in 464 cases of VATS lobectomies and 464 cases of open lobectomies who were well matched by ten potential prognostic factors including tumor size, T- and N-stage. VATS lobectomy was associated with less blood loss than open surgery (median: 60 vs. 100 mL, P=0.000), as well as fewer postoperative complications (15.1% vs. 20.3%, P=0.039). In addition, the VATS approach removed more lymph node stations (4.9±1.5 vs. 4.2±1.8, P=0.000). The postoperative hospital stay was shorter in the VATS group (7.7±3.8 vs. 8.3±4.3, P=0.019), but the total hospital costs were more expensive (48.4±11.3 vs. 35.5±9.4 kRMB, P=0.000). The matched cohorts revealed that VATS lobectomy for stage I-II NSCLC had improved 5-year overall survival (OS) than the open approach (71.1% vs. 65.4%, P=0.045).

Conclusions: The VATS lobectomy is associated with less blood loss, fewer postoperative complications, and shorter postoperative hospital stay when comparing with the open approach for stage I-II NSCLC. Despite more hospital costs, VATS lobectomy offer improved 5-year OS than the open approach. It is reasonable to recommend the VATS approach as the preferred option for the surgical treatment of stage I-II NSCLC.

Keywords: Lung cancer; outcome; overall survival (OS); thoracic surgery; thoracotomy; video-assisted thoracic surgery (VATS).