Thoracoscopic surgery for lung cancer is associated with improved survival and shortened admission length: a nationwide propensity-matched study

Abstract

OBJECTIVES Population-based studies comparing long-term survival after minimally invasive and open surgery for lung cancer are lacking. The aim of this study was to compare long-term survival rates between minimally invasive [video-assisted thoracoscopic surgery (VATS)] and open surgery for lung cancer in an unselected nationwide setting. METHODS Patients undergoing minimally invasive (n = 710) or open (n = 2814) lung resection for lung cancer between 2004 and 2014 were identified from nationwide complete registries in Finland. Propensity score matching resulted in groups of 632 patients who had VATS and 632 who had a thoracotomy. The primary outcome was the 1-year survival rate. Secondary outcomes were 30-day, 90-day and 5-year survival rates and the length of surgical admission. Cox models were adjusted for sex, age, comorbidity, centre size, year of surgery, histological diagnosis, stage and adjuvant therapy. RESULTS In the propensity-matched cohort, the 1-year survival rate was 90.8% [confidence interval (CI) 88.3–92.8%] after VATS and 87.1% (CI 84.3–89.6%) after open surgery. The 5-year survival rate in the propensity-matched cohort was 59.6% (CI 54.9–63.9%) after VATS and 53.3% (CI 48.6–57.7%) after open surgery. The 30-day mortality rates showed no differences between approaches, but the 90-day mortality rate was better after VATS when adjusted for patient-, tumour- and operation-specific features (hazard ratio 0.56, 95% CI 0.30–0.92; P = 0.024). CONCLUSIONS According to this population-based nationwide study from Finland, minimally invasive surgery for lung cancer is associated with improved long- and short-term survival rates, supporting the use of VATS as a primary surgical method for treating lung cancer. Due to the complexity of confounding factors in this study, one should, however, interpret the results critically. Additional studies are needed.

Survival After Thoracoscopic Surgery or Open Lobectomy: Systematic Review and Meta-Analysis

“…[2][3][4][5][6][7][8][9][11][12][13] Four studies were RCTs, 2,11-13 2 were PSW studies, 38,42 and 27 were PSM studies. [3][4][5][6][7][8][9][25][26][27][28][29][30][31][32][33][34][35][36][37][39][40][41][43][44][45][46] Table 1 provides an overview of the articles identified for our systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram can be consulted in Supplemental Figure 1.…”

“…Of 33 works [2][3][4][5][6][7][8][9][11][12][13] , 28 [2][3][4][5][6][7][8][9]11,13,[26][27][28][29][30][31][32][34][35][36][37][39][40][41][42][43][44][45] provided postoperative mortality. Nine studies had no deaths in any arm and had to be excluded from the metaanalysis.…”

“…There were 21 studies 5,6,12,25,[27][28][29][30][31]33,34,36,[38][39][40][41][42][43][44][45][46] providing data on long-term overall survival. The study by Oda and colleagues 43 had to be excluded given the inability to calculate the HR because of the absence of deaths in 1 of the groups.…”

The Uncomfortable Truth: Open Thoracotomy versus Minimally Invasive Surgery in Lung Cancer: A Systematic Review and Meta-Analysis

“…At that point, VATS had been validated worldwide for a long time [7][8][9][10][11][12][13][14][15][16][17][18][19]. Many leading groups in the field of thoracic surgery in various countries have applied VATS to more surgeries, proving its safety and effectiveness and expanding its indications since its initial introduction.…”

Feasibility of video-assisted thoracoscopic sleeve lobectomy for non-small cell lung cancer

“…Pattern of recurrenceYeong Jeong Jeon, et al lung function, reduced hospital stay duration, and reduced postoperative chest tube drainage duration[17][18][19]. Nevertheless, the use of VATS in patients with centrally located lung cancer who need sleeve bronchial resection is still controversial because of oncological efficacy and because it is…”