Outcomes for Thoracoscopy Versus Thoracotomy Not Just Technique Dependent: A Study of 9,787 Patients

Abstract

Numerous patient- and hospital-related variables that affect morbidity and mortality also affect whether a patient undergoes VATS or open lung resection. Studies evaluating VATS must account more accurately for selection bias and adjust for these confounders.

Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer

“…Treatment outcomes extracted from SPARCS included complications and in-hospital mortality. Complications were identified by diagnosis codes and categorized as cardiovascular, pulmonary, infectious, and intraoperative, following a previously published approach [19,20]. All corresponding ICD-9 codes are provided in the Supplemental Tables 1 and 2.…”

Video-Assisted Thoracoscopic Lobectomy for Lung Cancer

“…Some adverse events are rare in the modern era (ie, 1% operative mortality rates [57]) limiting the power to compare outcomes even with the use of large population-based datasets. Retrospective studies comparing VATS and thoracotomy suggest noninferiority of VATS [18,24,58], morbidity [24,25,27,59,60], LOS [18,24,28,59], and costs [18,44]. Randomized trials show no evidence of a difference in morbidity, mortality, or LOS between VATS and open lobectomy [29,30,61].…”

Invited Commentary

“…Dr Wolf and colleagues [1] add to an ever growing body of literature that compares outcomes between thoracotomy and a video-assisted thoracoscopic surgical (VATS) approach to lobar and sublobar resection. They hypothesized that there would be no relationship between VATS and outcomes after adequately controlling for selection bias.…”

“…Most retrospective and single-institution studies show an association between VATS and better short-term outcomes. However, Wolf and colleagues [1] provide citations for studies in which there is no association between VATS and short-term outcomes. In addition, a recent prospective study from Memorial Sloan-Kettering showed no evidence of a relationship between VATS and patient-reported health-related quality-of-life or pain scores at 12 months.…”