P1.08-042 Overall Survival and Tumor Recurrence after VATS Lobectomy of N1 Positive NSCLC is Equal to Open Resection

Abstract

Video-assisted thoracoscopic surgery (VATS) is an accepted alternative to open resection for early stage non-small cell lung cancer. This study was performed to analyze survival after primary VATS anatomic resection for nodal positive NSCLC compared to an open approach. The prospective institutional VATS database was searched for pN1 patients after primary surgery for NSCLC (62/504 patients between February 2009 and December 2015). Exclusion criteria were neoadjuvant treatment and conversion to thoracotomy. Demographics and survival were compared to a historic group of N1 positive patients, who underwent primary open surgery via a standard posterolateral thoracotomy for lung cancer between 2002 and 2007 (57 patients). Age (65 vs 61.5 years), gender and stage distribution (UICC IIA vs >IIA) did not differ between the VATS and open group. Half of the patients in the VATS group had clinical stage N0 (31/62) confirmed by PET-CT. More people received adjuvant therapy after VATS lobectomy (50/62 vs 31/57, p=0.003). Median follow up was 22 months in the VATS group and 47 months in the open group (p<0.0001). Disease recurrence occurred in 16/62 and 22/57 patients after a median of 13 and 12 months, respectively, (p=0.1692). Overall survival did not differ between the two groups (Figure 1, log rank, p=0.4006). No survival difference was found between unforeseen and clinically evident nodal positive patients in the VATS group (p=0.9686). VATS lobectomy in nodal positive lung cancer patients is oncologically equal to open resection with similar survival and recurrence rates. Half of the lymph node metastases have been missed by clinical staging. Interestingly, the higher rate of patients receiving adjuvant chemotherapy after VATS lobectomy did not result in significant better survival.