A comparison of perioperative outcomes of Video-Assisted Thoracic Surgical (VATS) Lobectomy with open thoracotomy and lobectomy: Results of an analysis using propensity score based weighting

Walter J Scott,Ronald S Matteotti,Salewa Oseni,Brian L Egleston,James F Flaherty

doi:10.1186/1750-1164-4-1

Walter J Scott, Ronald S Matteotti + Show 3 more

Open Access

https://doi.org/10.1186/1750-1164-4-1

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Abstract

BackgroundRandomized trials comparing VATS lobectomy to open lobectomy are of small size. We analyzed a case-control series using propensity score-weighting to adjust for important covariates in order to compare the clinical outcomes of the two techniques.MethodsWe compared patients undergoing lobectomy for clinical stage I lung cancer (NSCLC) by either VATS or open (THOR) methods. Inverse probability of treatment weighted estimators, with weights derived from propensity scores, were used to adjust cohorts for determinants of perioperative morbidity and mortality including age, gender, preop FEV1, ASA class, and Charlson Comorbidity Index (CCI). Bootstrap methods provided standard errors. Endpoints were postoperative stay (LOS), chest tube duration, complications, and lymph node retrieval.ResultsWe analyzed 136 consecutive lobectomy patients. Operative mortality was 1/62 (1.6%) for THOR and 1/74 (1.4%) for VATS, P = 1.00. 5/74 (6.7%) VATS were converted to open procedures. Adjusted median LOS was 7 days (THOR) versus 4 days (VATS), P < 0.0001, HR = 0.33. Adjusted median chest tube duration (days) was 5 (THOR) versus 3 (VATS), P < 0.0001, HR = 0.42. Complication rates were 39% (THOR) versus 34% (VATS), P = 0.61. Adjusted mean number of lymph nodes dissected per patient was 18.1 (THOR) versus 14.8 (VATS), p = 0.17.ConclusionsAfter balancing covariates that affect morbidity, mortality and LOS in this case-control series using propensity-weighting, the results confirm that VATS lobectomy is associated with a statistically significant shorter LOS, similar mortality and complication rates and similar rates of lymph node removal in patients with clinical stage I NSCLC.

Highlights

The routine use of video-assisted thoracic surgical (VATS) lobectomy for the treatment of resectable nonsmall cell lung cancer (NSCLC) remains controversial
There were 62 patients from 2003 through late-2005 who underwent lobectomy performed through an open thoracotomy and 74 patients who underwent VATS lobectomy from late 2005 through mid-2008
There were no significant differences between groups with respect to clinical stage, pathologic stage and histology (Table 4)

Summary

Introduction

The routine use of video-assisted thoracic surgical (VATS) lobectomy for the treatment of resectable nonsmall cell lung cancer (NSCLC) remains controversial. Data supporting the use of VATS lobectomy come from randomized trials [1,2,3,4], a multicenter phase II study [5], case-control series and large retrospective series [6]. The randomized trials enrolled relatively small numbers of patients and retrospective case series are subject to selection biases. Most case-control techniques attempt to decrease the effect of selection bias when comparing two non-randomized treatment groups by analyzing patients that are “matched” based on preoperative variables that are known to affect the outcomes that are being studied. At times, eliminating the cases that cannot be matched may result in an increase in selection bias, casting doubt on the conclusion that differences in outcomes between the two groups are due to treatment effects [11]. We analyzed a case-control series using propensity score-weighting to adjust for important covariates in order to compare the clinical outcomes of the two techniques

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