Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer Journal Article

Authors: Flores, R. M.; Park, B. J.; Dycoco, J.; Aronova, A.; Hirth, Y.; Rizk, N. P.; Bains, M.; Downey, R. J.; Rusch, V. W.
Article Title: Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer
Abstract: Background: The optimal surgical technique for lobectomy in lung cancer is not well defined. Proponents of video-assisted thoracic surgery (VATS) hypothesize that less trauma leads to quicker recovery, whereas those who advocate thoracotomy claim it as an oncologically superior procedure. However, a well-balanced comparison of the two procedures is lacking in the literature. Methods: All patients who underwent lobectomy for clinical stage 1A lung cancer by computed tomographic and positron emission tomographic scan were identified from a prospective database. Patient characteristics were compared by the Student t test, Pearson χ<sup>2</sup>, and Fisher exact test. A propensity score-matched analysis was performed. Survival was assessed by Kaplan-Meier and Cox proportional hazards analysis. Complications were assessed by a multivariate logistic regression model evaluating age, sex, comorbidities, pulmonary function, tumor size, nodal status, surgeon, and histologic characteristics. Results: From May 2002 to August 2007, 398 patients underwent an attempt at VATS lobectomy and 343 underwent thoracotomy. An "intent-to-treat" analysis was performed. There was 1 postoperative death in each group. Survival by Cox model was no different for VATS versus thoracotomy (hazard ratio 0.72; P = .12), whereas age (hazard ratio 1.03; P &lt; .001), larger tumor size (hazard ratio 1.34; P &lt; .001), and higher nodal stage (hazard ratio 1.92; P &lt; .001) were associated with worse survival. Logistic regression demonstrated fewer complications for VATS lobectomy (odds ratio 0.73; P = .06), whereas age (odds ratio 1.04; P &lt; .001) and tumor size (odds ratio 1.2; P &lt; .020) correlated with a greater number of complications. Patients undergoing VATS lobectomy demonstrated a 2-day shorter length of stay than patients undergoing thoracotomy (P &lt; .001). Propensity score-matched analysis supported these findings. Conclusions: VATS lobectomy and thoracotomy demonstrated similar 5-year survivals. However, VATS lobectomy was associated with fewer complications and shorter length of hospital stay. © 2009 The American Association for Thoracic Surgery.
Keywords: cancer survival; controlled study; cancer patient; cancer staging; positron emission tomography; prospective study; lymphadenectomy; computer assisted tomography; tumor volume; bleeding; thoracotomy; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; lung cancer; data base; histology; lung embolism; postoperative complication; length of stay; hospitalization; heart infarction; surgeon; endoscopic surgery; comorbidity; scoring system; surgical mortality; lung function; air leak; empyema; gastrointestinal disease; heart atrium arrhythmia; lobectomy; thoracic surgery, video-assisted; major clinical study
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 138
Issue: 1
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2009-07-01
Start Page: 11
End Page: 18
Language: English
DOI: 10.1016/j.jtcvs.2009.03.030
PUBMED: 19577048
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 14" - "Export Date: 30 November 2010" - "CODEN: JTCSA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Valerie W Rusch
    761 Rusch
  2. Nabil Rizk
    139 Rizk
  3. Raja Flores
    108 Flores
  4. Bernard J Park
    195 Park
  5. Robert J Downey
    228 Downey
  6. Joseph Dycoco
    30 Dycoco
  7. Manjit S Bains
    289 Bains