Video-Assisted Vs Thoracotomy Sleeve Lobectomy for Lung Cancer: A Propensity Matched Analysis

Abstract

In this retrospective study, we evaluated the safety and efficacy of video-assisted thoracic surgery (VATS) sleeve lobectomy for patients with centrally located non-small cell lung cancer. All consecutive patients who received VATS sleeve lobectomy (n= 54) and thoracotomy sleeve lobectomy (n= 94) were analyzed retrospectively; after propensity score matching, 78 paired cases were selected for further statistical analysis. Among all patients, the VATS group showed significantly better recurrence-free survival and overall survival than the thoracotomy group (P= .025 and P= .026, respectively) with smaller total tumor size and earlier pathological tumor-node-metastasis (TNM) stage. Nevertheless, after matching, the recurrence-free survival (50.9% vs 48.7%; P= .445) and overall survival (79.5% vs 66.7%; P= .198) were not significantly different. There was significantly less blood loss (228 vs 246 mL; P= .022), shorter thoracic drainage stay (4.6 vs 6.8 days; P < .001), and postoperative hospital stay (9.2 vs 11.3 days; P= .033) in the VATS group. Multivariate Cox analyses demonstrated that the surgical procedure was not an independent prognostic factor for recurrence-free survival, not only for patients with an invasive component size of 3 cm or less and negative lymphatic invasion, but for locally advanced patients with an invasive tumor size >3 cm (hazard ratio: 0.94; 95% confidence interval: 0.36-2.45; P= .55) or positive lymphatic invasion (hazard ratio: 0.91; 95% confidence interval: 0.35-2.39; P= .41). VATS sleeve lobectomy is a safe and effective procedure associated with better postoperative recovery and equivalent oncological results, even for locally advanced non-small cell lung cancer patients with an invasive tumor size larger than 3 cm or accompanying lymphatic invasion.