Abstract
Objectives
Video-assisted thoracoscopic surgery (VATS) lobectomy is performed widely for patients with clinical stage I non-small cell lung cancer (NSCLC) because of its superior short-term outcomes to those of thoracotomy lobectomy. However, the long-term outcomes of VATS lobectomy vs. thoracotomy lobectomy remain controversial.
Methods
We reviewed the clinical data of 202 consecutive patients who underwent lobectomy for clinical stage IA NSCLC at our institution between January, 2008 and December, 2013. Stage IA NSCLC was confirmed pathologically in 162 of these patients, 60 of whom underwent VATS lobectomy and 102 of whom underwent thoracotomy lobectomy. We compared the perioperative clinical factors and outcomes of these two groups, using a propensity score-matched analysis.
Results
In an analysis of 58 matched cases, the VATS group showed less blood loss, a shorter duration of chest tube placement, a shorter postoperative hospital stay, and a lower peak C-reactive protein value, despite a longer operative time. The VATS group also had significantly longer survival than the thoracotomy group [5-year overall survival, 100% vs. 87%, respectively (p = 0.01); 5-year disease-free survival, 100% vs. 86% (p = 0.03)].
Conclusions
These findings suggest that VATS may have better long-term as well as short-term outcomes than thoracotomy for patients with early-stage NSCLC.
Similar content being viewed by others
References
Su S, Scott WJ, Allen MS, Darling GE, Decker PA, McKenna RJ, et al. Patterns of survival and recurrence after surgical treatment of early stage non-small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial. J Thorac Cardiovasc Surg. 2014;147:747–52.
Rueth NM, Andrade RS. Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg. 2010;89:2107–11.
Boffa DJ, Dhamija A, Kosinski AS, Kim AW, Detterbeck FC, Mitchell JD, et al. Fewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer. J Thorac Cardiovasc Surg. 2014;148:637–43.
Yang HX, Woo KM, Sima CS, Bains MS, Adusumilli PS, Huang J, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage I non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg. 2017;265:431–7.
Lee PC, Nasar A, Port JL, Paul S, Stiles B, Chiu YL, et al. Long-term survival after lobectomy for non-small cell lung cancer by video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 2013;96:951–60.
Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013;48:452–8.
Cerfolio RJ, Bryant AS. Survival of patients with true pathologic stage I non-small cell lung cancer. Ann Thorac Surg. 2009;88:917–22.
Boffa DJ, Kosinski AS, Paul S, Mitchell JD, Onaitis M. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg. 2012;94:347–53.
Decaluwé H, Stanzi A, Dooms C, Fieuws S, Coosemans W, Depypere L, et al. Central tumour location should be considered when comparing N1 upstaging between thoracoscopic and open surgery for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg. 2016;50:110–7.
Nakamura H, Sakai H, Kimura H, Miyazawa T, Marushima H, Saji H. Chronological changes in lung cancer surgery in a single Japanese institution. Onco Targets Ther. 2017;10:1459–64.
Pastorino U, Morelli D, Leuzzi G, Gisabella M, Suatoni P, Taverna F, et al. Baseline and postoperative C-reactive protein levels predict mortality in operable lung cancer. Eur J Cancer. 2017;79:90–7.
Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;20:455–63.
Nakanishi R, Fujino Y, Oka S, Odate S. Video-assisted thoracic surgery involving major pulmonary resection for central tumors. Surg Endosc. 2010;24:161–9.
Forrest LM, McMillan DC, McArdle CS, Angerson WJ, Dunlop DJ. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer. Br J Cancer. 2003;89:1028–30.
Xia H, Sun Z, Deng L, Zhu D, Wang D. Prognostic significance of the preoperative lymphocyte to monocyte ratio in patients with stage I non-small cell lung cancer undergoing complete resection. Cancer Invest. 2016;34:378–84.
Nan Ding ZhaoFei, Pang H, Shen Y, Ni J, Du QL. The prognostic value of PLR in lung cancer, a meta-analysis based on results from a large consecutive cohort. Sci Rep. 2016;6:34823.
Bryant AS, Cerfolio RJ. The analysis of a prospective surgical database improves postoperative fast-tracking algorithms after pulmonary resection. J Thorac Cardiovasc Surg. 2009;5:1173–9.
Nakanishi R, Fujino Y, Yamashita T, Oka S. A prospective study of the association between drainage volume within 24 h after thoracoscopic lobectomy and postoperative morbidity. J Thorac Cardiovasc Surg. 2009;6:1394–9.
Guerrera F, Errico L, Evangelista A, Filosso PL, Ruffini E, Lisi E, et al. Exploring stage I non-small-cell lung cancer: development of a prognostic model predicting 5-year survival after surgical resection. Eur J Cardiothorac Surg. 2015;47:1037–43.
Wu CF, Fu JY, Yeh CJ, Liu YH, Hsieh MJ, Wu YC, et al. Recurrence risk factors analysis for stage I non-small cell lung cancer. Medicine (Baltimore). 2015;94:e1337.
Vallières E, Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, et al. The IASLC lung cancer staging project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:1049–59.
Buhr J, Hürtgen M, Kelm C, Schwemmle K. Tumor dissemination after thoracoscopic resection for lung cancer. J Thorac Cardiovasc Surg. 1995;110:855–6.
Kurusu Y, Yamshita J, Hayashi N, Mita S, Fujino N, Ogawa M. The sequence of vessel ligation affects tumor release into the circulation. J Thorac Cardiovasc Surg. 1998;116:107–13.
Maeyashiki T, Suzuki K, Hattori A, Matsunaga T, Takamochi K, Oh S. The size of consolidation on thin-section computed tomography is a better predictor of survival than the maximum tumour dimension in resectable lung cancer. Eur J Cardiothorac Surg. 2013;43:915–8.
Aokage K, Miyoshi T, Ishii G, Kusumoto M, Nomura S, Katsumata S, et al. Influence of ground glass opacity and the corresponding pathological findings on survival in patients with clinical stage I non-small cell lung cancer. J Thorac Oncol. 2018;13:533–42.
Pagès PB, Delpy JP, Orsini B, Gossot D, Baste JM, Thomas P, et al. Propensity score analysis comparing videothoracoscopic lobectomy with thoracotomy: a French Nationwide Study. Ann Thorac Surg. 2016;101:1370–8.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest to declare.
Rights and permissions
About this article
Cite this article
Oda, R., Okuda, K., Osaga, S. et al. Long-term outcomes of video-assisted thoracoscopic surgery lobectomy vs. thoracotomy lobectomy for stage IA non-small cell lung cancer. Surg Today 49, 369–377 (2019). https://doi.org/10.1007/s00595-018-1746-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-018-1746-4