Outcomes of video assisted thoracic surgery compared with open thoracotomy in patients with early stage lung cancer.

Abstract

e20061 Background: Video Assisted Thoracic Surgery (VATS) has become the recommended approach for treatment of early stage lung cancer; however, no large randomized clinical trial has been conducted to formally compare VATS to open thoracotomy (OT). The current study sought to assess differences in patients and tumor characteristics for VATS and OT. Additionally, treatment outcomes that included margin status, postoperative length of stay (LOS) and overall survival (OS) were also compared. Methods: A single institution retrospective charts review was conducted for patients diagnosed with stage I-III lung cancer and treated with VATS or OT from May 2005 - May 2015. Patients and tumor characteristics included age at diagnosis, sex, tobacco use, tumor location, stage, size and receipt of chemotherapy or radiotherapy. Chis-square and Wilcoxon-Mann-Whitney tests were used to compare demographic, tumor characteristics and LOS. Multiple logistic and Cox regressions were used to compute relative risk (RR) for positive margins and mortality hazards ratio along with 95 percent confidence interval limits (95%CI), respectively. Results: A total of 232 patients underwent lung resection for cancer diagnosis; VATS n = 99 and OT n = 133. Age at diagnosis, sex, tobacco use, tumor location, and size were not significantly different between the two groups. VATS was more frequently performed for stage I lung cancer compared to OT, p = 0.043. The risk of positive margin RR = 0.49 (95%CI = 0.15, 1.60) and mortality HR = 1.49 (95%CI = 0.90, 2.46) were similar between the two groups. However, the median LOS was significantly shorter (4 days) for VATS than OT (6 days), p = 0.001. Conclusions: Our results show that both short and long-term oncologic outcomes are comparable between VATS and OT. VATS results in shorter LOS and should be considered as the approach of choice for patients undergoing lung resection for cancer. [Table: see text]