Thoracoscopic Versus Open Segmentectomy for Stage I Non-Small Cell Lung Cancer (NSCLC): 221 Consecutive Cases
Matthew J. Schuchert, Brian L. Pettiford, Ghulam Abbas, Omar Awais, Arman Kilic, Robert Jack, James R. Landreneau, Joshua P. Landreneau, James D. Luketich, Rodney J. Landreneau; Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
Comment on this Abstract
Objective: Anatomic segmentectomy is increasingly being considered as a means of achieving an R0 resection for peripheral, small stage I NSCLC. The use of VATS in accomplishing anatomic segmentectomy has been slow to gain favor due to perceived technical complexity and concerns regarding oncologic efficacy. In the current study, we compare the results of VATS (n=101) vs. open (n=120) segmentectomy in the treatment of stage I NSCLC.
Methods: A total of 221 consecutive anatomic segmentectomies were performed for Stage IA (n=135) or IB (n=86) NSCLC from 2002-2007. Primary outcome variables included hospital course, complications, mortality, recurrence patterns and survival. Statistical analysis included paired and one-sample t-tests. The probability of overall and recurrence-free survival was estimated with the Kaplan-Meier method, with significance being estimated by the log rank test.
Results: Mean age (69.8 years; range: 45-100) and gender distribution were similar between the VATS and Open groups. Average tumor size was 2.3 cm (2.1 cm VATS; 2.4 cm Open). There was no clinical difference in the average number of lymph nodes sampled between the VATS and open groups (mean=7.9). Mean follow-up was 20.7 months. There were two perioperative deaths (2/221; 0.9%), both in the Open group. VATS segmentectomy was associated with decreased length of stay and pulmonary complications compared to Open segmentectomy [see Table]. Overall mortality, complications, local and systemic recurrence, and survival were similar between VATS and Open segmentectomy groups.
Conclusion: VATS segmentectomy can be performed with acceptable morbidity, mortality, recurrence and survival. The VATS approach affords a shorter length of stay and fewer postoperative pulmonary complications compared with open techniques. The potential benefits of segmentectomy vs. lobectomy will need to be further evaluated by prospective, randomized trials (ACOSOG Z4032; CALGB-Altorki study). However, this data suggests that the VATS approach represents a safe and effective option when considering segmentectomy for early-stage lung cancer.
Comparison of Peri-Operative Outcomes Following VATS vs.Open Segmentectomy
| VATS(n=101) | Open(n=120) | Sig.(p-value) |
| Operative Time (min) | 136 | 143 | 0.56 |
| Estimated Blood Loss(ml) | 171 | 220 | 0.18 |
| Length of Stay (days) | 5 | 7 | 0.005 |
| PulmonaryComplications | 19 (18.8%) | 39 (32.5%) | 0.02 |
| Mortality | 0 (0%) | 2 (1.7%) | 0.50 |
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