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 < .001), larger tumor size (hazard ratio 1.34; P < .001), and higher nodal stage (hazard ratio 1.92; P < .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 < .001) and tumor size (odds ratio 1.2; P < .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 < .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 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 14" - "Export Date: 30 November 2010" - "CODEN: JTCSA" - "Source: Scopus" |
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