Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer.

Mitsunori Higuchi,Akio Ohishi,Ryuzo Kanno,Mitsukazu Gotoh,Hiroshi Yaginuma,Hiroyuki Suzuki,Atsushi Yonechi

doi:10.1186/1749-8090-9-88

Abstract

BackgroundVideo-assisted thoracic surgery (VATS) lobectomy is a standard treatment for lung cancer. This study retrospectively compared long-term outcomes after VATS lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer (NSCLC).MethodsFrom July 2002 to June 2012, 160 patients were diagnosed with clinical stage IA NSCLC and underwent lobectomy. Of these, 114 underwent VATS lobectomy and 46 underwent lobectomy via open thoracotomy.ResultsThe 5-year disease-free survival (DFS) rate was 88.0% in the VATS group and 77.1% in the thoracotomy group for clinical stage IA NSCLC (p = 0.1504), and 91.5% in the VATS group and 93.8% in the thoracotomy group for pathological stage IA NSCLC (p = 0.2662). The 5-year overall survival (OS) rate was 94.1% in the VATS group and 81.8% in the thoracotomy group for clinical stage IA NSCLC (p = 0.0268), and 94.8% in the VATS group and 96.2% in the thoracotomy group for pathological stage IA NSCLC (p = 0.5545). The rate of accurate preoperative staging was 71.9% in the VATS group and 56.5% in the thoracotomy group (p = 0.2611). Inconsistencies between the clinical and pathological stages were mainly related to tumor size, nodal status, and pleural invasion. Local recurrence occurred for one lesion in the VATS group and six lesions (five patients) in the thoracotomy group (p = 0.0495).ConclusionsThe DFS and OS were not inferior after VATS compared with thoracotomy. Local control was significantly better after VATS than after thoracotomy. Preoperative staging lacked sufficient accuracy.

Highlights

Video-assisted thoracic surgery (VATS) lobectomy is a standard treatment for lung cancer
Inconsistencies between the clinical and pathological stages were mainly related to tumor size (12.3% and 17.4%), nodal metastasis (9.6% and 17.4%), and pleural invasion (14.9% and 19.6%) in the VATS and thoracotomy groups, respectively (Table 2)
This study found that local control was better in the VATS group, and the prognosis of patients with pathological stage I non-small cell lung cancer (NSCLC) was not significantly different between the VATS and thoracotomy groups. These results suggest that VATS lobectomy is a feasible treatment for pathological stage IA NSCLC and indicate that differences in nodal upstaging result from patient selection

Summary

Introduction

Video-assisted thoracic surgery (VATS) lobectomy is a standard treatment for lung cancer. This study retrospectively compared long-term outcomes after VATS lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer (NSCLC). Lung cancer is the leading cause of cancer-related deaths worldwide [1]. Surgical resection of lung cancer in patients without metastasis to other organs may provide a long-term survival benefit compared with nonsurgical therapies. Robert McKenna first described video-assisted thoracic surgery (VATS) lobectomy in 1994 [2]. The findings of many studies have established with reasonable certainty that VATS lobectomy is associated with

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Discussion

Conclusion