Video-assisted thoracoscopic lobectomy versus open lobectomy in the treatment of large lung cancer: propensity-score matched analysis

• Published in: Journal of cardiothoracic surgery Vol. 17; no. 1; p. 2
• Main Authors: Yun, Jeonghee, Lee, Junghee, Shin, Sumin, Kim, Hong Kwan, Choi, Yong Soo, Kim, Jhingook, Zo, Jae Il, Shim, Young Mog, Cho, Jong Ho
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.01.2022; BioMed Central; BMC
• Subjects: Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - surgery; Cardiac arrhythmia; Care and treatment; Drug therapy; Histology; Hospitals; Humans; Large tumor; Lobectomy; Lung cancer; Lung cancer, Non-small cell; Lung Neoplasms - surgery; Lymphatic system; Magnetic resonance imaging; Matching; Medical prognosis; Morbidity; Mortality; Non-small cell lung cancer; Non-small cell lung carcinoma; Oncology, Experimental; Ostomy; Patients; Pneumonectomy; Pneumonia; Propensity Score; Pulmonary arteries; Retrospective Studies; Small cell lung carcinoma; Solid tumors; Surgery; Survival; Thoracic Surgery, Video-Assisted; Thoracotomy; Tomography; Treatment Outcome; Tumors; Video-assisted thoracoscopic surgery; Video-assisted thoracoscopic surgery; Lobectomy; Non-small cell lung cancer; Large tumor
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-021-01749-8

There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. This study aimed to compare perioperative outcomes and oncological validity between video-assisted thoracoscopic surgery (VATS) and open lobectomy for non-small cell lung cancer (NSCLC) with tumor size > 5 cm. We retrospectively reviewed 355 patients who underwent lobectomy with clinical N0 NSCLC with solid tumor component diameter > 5 cm between January 2009 and December 2016. Patients with tumor invading adjacent structures were excluded. The patients were divided into the VATS group (n = 132) and thoracotomy group (n = 223). Propensity score matching (1:1) was applied. After propensity score matching, 204 patients were matched, and clinical characteristics of the two groups were well balanced. The VATS group was associated with a shorter length of hospital stay (6 days vs. 7 days; P < 0.001) than the thoracotomy group. There were no significant differences in the 5-year overall survival (71.5% in VATS vs. 64.4% in thoracotomy, P = 0.390) and 5-year recurrence-free survival (60.1% in VATS vs. 51.5% in thoracotomy, P = 0.210) between the two groups. The cumulative incidence of ipsilateral pleural recurrence was not significantly different between the two groups (12.0% in VATS vs. 7.9% in thoracotomy; P = 0.582). In clinical N0 NSCLC larger than 5 cm, VATS lobectomy resulted in shorter hospital stay and similar survival outcome compared to open lobectomy. Based on these results, VATS lobectomy is a valuable option in this subset of patients.