Lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for clinical stage I / II non-small cell lung cancer: a multi-center comparative study

Abstract

Objective To compare safety,completeness and long-term results between lobectomy by video-assisted thoracoscopic surgery(VATS) and thoracotomy for clinical stage Ⅰ / Ⅱ non-small cell lung cancer(NSCLC).Methods Between July 2010 and December 2011,673 patients with clinical stage Ⅰ / Ⅱ NSCLC from 11 hospitals underwent pulmonary lobectomy(425 VATS,248 thoracotomy).Patients were matched by propensity score matoh method to create two comparable groups,402 patients remained eligible for analysis,with 201 patients in each group.Perioperative variables and follow-up results were compared between the two groups.Results Patients characteristics were comparable between the two groups,except for a slight lower preoperative FEV1,FEV1％ and FEV1/FVC in the VATS group (P ＜ 0.05).There was one postoperative death in each group.There was no significant difference in operative time,mediastinal lymph nodes stations/numbers dissected and postoperative drainage time between the two groups.The operative blood loss was lower in the VATS group(P ＜ 0.001),the mean hospital stay was shorter in the VATS group(P ＜ 0.001).Postoperative pneumonia/pulmonary atelectasis rate was lower in the VATS group than in the thoracotomy group (5.1％ vs.10.4％,P ＜ 0.05).Median follow-up time was 20 months in both groups.One-year and two-year recurrence-free survival was 90％ vs.88％ and 80％ vs.70％,respectively(P =0.163).One-year and two-year overall survival were 96％ vs.95％ and 88％ vs.85％,respectively(P =0.226).Conclusion For clinical stage Ⅰ / Ⅱ NSCLC,VATS lobectomy is a feasible procedure with shorter hospital stay and less complications,while its surgical and oncologic outcome is comparable to that of thoracotomy lobectomy. Key words: Carcinoma, Non-Small-Cell Lung ; Pneumonectomy ; Thoracoscopy ; Thoracotomy ; Propensity score