A National Analysis of Short-term Outcomes and Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Clinical Stage II Non-Small-Cell Lung Cancer

Abstract

Objective: To compare outcomes after open versus thoracoscopic (VATS) lobectomy for clinical stage II (cN1) non-small-cell lung cancer (NSCLC). Background: There have been no published studies evaluating the impact of a VATS approach to lobectomy for N1 NSCLC on short-term outcomes and survival. Methods: Outcomes of patients with clinical T1-2, N1, M0 NSCLC who underwent lobectomy without induction therapy in the National Cancer Data Base (2010–2012) were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Results: Median follow-up of 1559 lobectomies (1204 open and 355 VATS) was 43.2 months. The VATS approach was associated with a shorter median hospitalization (5 vs 6 d, P < 0.001) than the open approach. There were no significant differences between the VATS and open approach with regard to nodal upstaging (12.0% vs 10.5%, P = 0.41), 30-day mortality (2.3% vs 3.1%, P = 0.31), and overall survival (5-yr survival: 48.6% vs 48.7%, P = 0.76; multivariable-adjusted HR for VATS approach: 1.08, 95% CI: 0.90–1.30, P = 0.39). A propensity score-matched analysis of 334 open and 334 VATS patients who were well matched by 14 common prognostic covariates, including tumor size, and comorbidities, continued to show no significant differences in nodal upstaging, 30-day mortality, and 5-year survival between the VATS and open groups. Conclusion: In this national analysis, VATS lobectomy was used in the minority of N1 NSCLC cases but was associated with shorter hospitalization and similar nodal upstaging rates, 30-day mortality, and long-term survival when compared to open lobectomy. These findings suggest thoracoscopic techniques are feasible for the treatment of stage II (cN1) NSCLC.

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

“…In contrast, similar postoperative complications were observed between converted and planned thoracotomy patients 20,21 . A recent study based on the National Cancer Database also reported similar complication rates and long-term survival between patients with planned and converted thoracotomy for clinical N1 disease 9 . In our study, the rate of thoracotomy conversion was 19% (23/121), and the rate of emergency cases due to vascular injury was 13.0% (3/23).…”

Robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy

“…Medbery et al [27] reported a lower rate of nodal upstaging with VATS than with open surgery (P < 0.001), but, in the subgroup of patients operated on in a university hospital, there was no difference between groups (P = 0.08). Recently, Yang et al [28] reported an absence of difference in the rate of nodal upstaging of patients with clinical T1-T2 N1 MO NSCLC and performed by VATS or open surgery (12% and 10.5%, respectively, P = 0.41). The five-year overall survival was not different between the two groups (48.6% and 48.7%, respectively, P = 0.76).…”

VATS and Minimally Invasive Resection in Early-Stage NSCLC

“…A recent study of patients with cT1-2N1M0 NSCLC demonstrated that while VATS lobectomy was used in a minority of cases, there were no significant differences with regard to rates of nodal upstaging, 30-day mortality, or long-term survival. 44…”