Favourable outcomes in patients with early-stage non-small-cell lung cancer operated on by video-assisted thoracoscopic surgery: a propensity score-matched analysis.

Abstract

The video-assisted thoracoscopic surgery (VATS) approach has become a standard for the treatment of early-stage non-small-cell lung cancer (NSCLC). Recently published meta-analyses proved the benefit of VATS versus thoracotomy for overall survival (OS) and reduction of postoperative complications. The aim of this study was to compare early outcomes, long-term survival and rate of postoperative complications of the VATS approach versus thoracotomy. In this retrospective cohort study, we analysed 982 individuals who underwent surgical resection for Stage I-IIA NSCLC between 2007 and 2015. Thirty- and 90-day mortality rates, length of hospital stay, rate of complications and OS were assessed. Propensity score matching was performed to compare 2 groups of patients. Two hundred and twenty-five individuals from the thoracotomy group and 225 patients from the VATS group were matched regarding pTNM, sex, the Charlson comorbidity index, type of resection and histological diagnosis. In the propensity score-matched patient group, the VATS approach was associated with a significant benefit regarding OS (P = 0.042). Although no significant difference was observed (P = 0.14) in the 3-year survival rate of patients who had a thoracotomy versus VATS, the 5-year survival rate among patients with VATS increased significantly (61% vs 78%, P = 0.0081). The adjusted VATS-related hazard ratio for pTNM, sex and age was 0.63 (95% confidence interval 0.40-0.98). The VATS surgical approach also reduced both the rate of postoperative atelectasis (4% for VATS vs 10% for open thoracotomy; P = 0.0052) and the need for blood transfusions (4% vs 12% respectively, P = 0.0054) and significantly shortened the postoperative length of stay (mean 7.25 vs 9.34 days, P < 0.0001). No significant differences in the 30-day mortality (1% vs 1%, P = 0.66) and 90-day mortality (1% vs 1%, P = 0.48) rates were observed. Patients with early-stage NSCLC operated on with VATS had fewer complications, shorter postoperative length of stay and better OS compared to those who were operated on by thoracotomy.