Abstract
BackgroundThere are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. This study aimed to compare perioperative outcomes and oncological validity between video-assisted thoracoscopic surgery (VATS) and open lobectomy for non-small cell lung cancer (NSCLC) with tumor size > 5 cm.MethodsWe retrospectively reviewed 355 patients who underwent lobectomy with clinical N0 NSCLC with solid tumor component diameter > 5 cm between January 2009 and December 2016. Patients with tumor invading adjacent structures were excluded. The patients were divided into the VATS group (n = 132) and thoracotomy group (n = 223). Propensity score matching (1:1) was applied.ResultsAfter propensity score matching, 204 patients were matched, and clinical characteristics of the two groups were well balanced. The VATS group was associated with a shorter length of hospital stay (6 days vs. 7 days; P < 0.001) than the thoracotomy group. There were no significant differences in the 5-year overall survival (71.5% in VATS vs. 64.4% in thoracotomy, P = 0.390) and 5-year recurrence-free survival (60.1% in VATS vs. 51.5% in thoracotomy, P = 0.210) between the two groups. The cumulative incidence of ipsilateral pleural recurrence was not significantly different between the two groups (12.0% in VATS vs. 7.9% in thoracotomy; P = 0.582).ConclusionsIn clinical N0 NSCLC larger than 5 cm, VATS lobectomy resulted in shorter hospital stay and similar survival outcome compared to open lobectomy. Based on these results, VATS lobectomy is a valuable option in this subset of patients.
Highlights
There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage
Study cohort The study cohort consisted of 355 patients with clinical N0 non-small cell lung cancer (NSCLC) with solid tumor component diameters > 5 cm on chest computed tomography (CT)
A total of 132 (37.2%) patients were assigned to the video-assisted thoracoscopic surgery (VATS) group and 223 (62.8%) patients were assigned to the thoracotomy group
Summary
There are several concerns on thoracoscopic surgery for large tumors because of the increased risk of tumor cell spillage. Yun et al Journal of Cardiothoracic Surgery (2022) 17:2 surgery on large tumors because thoracoscopic manipulation of large tumors is challenging and extraction of large tumors through a small incision may increase the risk of tumor rupture or cancer cell spillage [7] There is another concern regarding the adequacy of mediastinal lymph node assessment of VATS lobectomy, as larger tumors have more unexpected lymph node metastases [8,9,10,11,12,13]. These studies showed that short- and long-term overall survival (OS) was not different between VATS and thoracotomy for patients with NSCLC with tumor size > 5 cm [14, 15] These studies had a small sample size, heterogeneous population between treatment groups, and no information on cancer recurrence. We measured the solid component diameter of the tumor to define clinical tumor size because this measurement better predicts prognosis than the total tumor size [16,17,18,19,20]
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