Video-assisted thoracoscopic lobectomy is feasible for selected patients with clinical N2 non-small cell lung cancer

Jae Kwang Yun,Sehoon Choi,Seung-Il Park,Yong-Hee Kim,Geun Dong Lee,Dong Kwan Kim,Hyeong Ryul Kim

doi:10.1038/s41598-020-72272-4

Abstract

Few studies have evaluated the usefulness of video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer. We aimed to evaluate the feasibility of VATS for treating clinical N2 (cN2) lung cancer. A retrospective cohort analysis was performed with data from 268 patients who underwent lobectomy for cN2 disease from 2007 to 2016. Using propensity score-based inverse probability of treatment weighting (IPTW), perioperative and long-term survival outcomes were compared. We performed VATS and open thoracotomy on 121 and 147 patients, respectively. Overall, VATS was preferred for patients with peripherally located tumors (p < 0.001). After IPTW-adjustment, all preoperative information became similar between the groups. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.1 days, p = 0.028), despite equivalent complete resection rates (92.6% vs. 90.5%, p = 0.488) and dissected lymph nodes (mean, 31.9 vs. 29.4, p = 0.100). On IPTW-adjusted analysis, overall survival (50.5% vs. 48.4%, p = 0.127) and recurrence-free survival (60.5% vs 44.6%, p = 0.069) at 5 years were also similar between the groups. Among selected patients with resectable cN2 disease and peripherally located tumors, VATS is feasible, associated with shorter hospitalization and comparable perioperative and long-term survival outcomes, compared with open thoracotomy.

Highlights

Few studies have evaluated the usefulness of video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer
We evaluated the perioperative and long-term outcomes of non-small cell lung cancer (NSCLC) patients who received VATS versus open lobectomy for the treatment of clinical stage IIIA cancer due to suspected N2 node metastasis
The VATS approach was associated with a shorter length of hospitalization and time to initial postoperative chemotherapy compared with the open thoracotomy approach

Summary

Introduction

Few studies have evaluated the usefulness of video-assisted thoracoscopic surgery (VATS) for advanced-stage lung cancer. Among selected patients with resectable cN2 disease and peripherally located tumors, VATS is feasible, associated with shorter hospitalization and comparable perioperative and long-term survival outcomes, compared with open thoracotomy. Since the introduction of video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomy in 1 9941, it has become a preferred surgical approach for early-stage non-small cell lung cancer (NSCLC)[2,3]. Owing to the limited comparative data on VATS and open thoracotomy in this cohort, applying VATS to patients with cN2 disease raises concerns about the possibility of incomplete lymph node (LN) dissection, technical challenges for anatomical dissection, and the consequent compromised long-term oncologic outcomes. We compared long-term oncologic outcomes between VATS and thoracotomy using an inverse probability of treatment weighting (IPTW) technique

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Conclusion