Surgical therapy for early stage non small cell lung cancer: VATS versus Thoracotomy

Abstract

Objectives: Non-Small Cell Lung Cancer (NSCLC) is the common cancer and the leading cause death of cancer. Lobectomy and lymph node dissection is optimal surgical treatment method for early stage of NSCLC. Video-assisted thoracoscopic surgery (VATS) approach is less trauma, quickly recovery, whereas those who advocate thoracotomy claim it as an ontologically superior procedure.
 The aims of the study are to evaluate the role of Video-Assisted Thoracoscopic Surgery for treating the patients who have early stage of NSCLC and comparing with conventional thoracotomy.
 Methods: All of patients with NSCLC in stage IA - IIB underwent lobectomy and lymph node dissection through VATS or thoracotomy are collected. Patient characteristics are compared. Operative data, complications are assessed and survived is assessed by Kaplan–Meier and Cox proportional hazards analysis. Follow-up from 14 to 66 months.
 Results: From May 2008 to August 2016, 57 patients with NSCLC stage IA - IIB underwent an attempt at VATS lobectomy and 60 patients underwent thoracotomy. There are 75 males and 42 females, mean age is 56.3, range 31 - 84. Lobectomy was performed in 106 cases and bilobectomy was performed in 11 cases. The mean operating time in VATS group is 157 minutes longer than conventional thoracotomy, which was 124 minutes. There was no statistic difference between 2 groups separated based on characteristics of patients. In 57 cases VATS, 5 cases were converted to thoracotomy. There was one death in conventional thoracotomy group. One patient had bleeding, needed to be re-operationed to control bleeding in each group. Prolonged air-leak presented in 7 cases (10.7%) in thoracotomy and 2 cases (3.8%) in VATS group. Hospitalization is 18.4 days in thoracotomy group and 12.8 days in VATS group. The 5-year OS rate was 67.8% in the VATS group and 71.6% in the thoracotomy group (p = 0.156). The 5-year DFS rate was 59.6% in the VATS group and 65.9% in the thoracotomy group (p = 0.065). Survival by Cox model was no different for VATS versus thoracotomy (hazard ratio 0.82; P = .21)
 Conclusion: Video-assisted thoracoscopic surgery is effective and safe method for surgical treatment of early stage of NSCLC. Surgery remains the primary therapy in the treatment of early-stage lung cancer. VATS was associated with less complication and shorter length of hospital stay. The 5 years survival is similar in VATS and conventional thoracotomy approach.