VATS lobectomy versus thoracotomy for lung cancer. Results in 741 patients
Raja M. Flores, Bernard J. Park, Joseph Dycoco, Anna Arnova, Yael Hirth, Nabil P. Rizk, Manjit Bains, Robert J. Downey, Valerie W. Rusch; Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
Comment on this Abstract
Objective: The optimal surgical technique for lobectomy in lung cancer is controversial. Proponents of VATS hypothesize that less trauma leads to quicker recovery while those who advocate thoracotomy claim it as an oncologically superior operation. However, a well balanced comparison of the two procedures is lacking in the literature.
Methods: All patients were selected for VATS or thoracotomy by a surgeon at initial evaluation at a single institution. Two surgeons exclusively performed thoracotomy lobectomy while 4 surgeons performed VATS lobectomy. All patients who underwent lobectomy for clinical stage 1A non-small cell lung cancer by CT and PET were identified from a prospective database. Variables recorded included age, sex, comorbidities, pulmonary function, tumor size, nodal status, and histology. Complications were classified and graded by the Cancer Institute Common Toxicity Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html). Patient characteristics were compared by student’s t-test, Pearson chi squared, and Fisher’s exact test. Survival was assessed by Kaplan-Meier and Cox proportional hazards analysis. Complications were assessed by a multivariate logistic regression model. A p value of less than 0.05 was considered statistically significant.
Results: From May 2002 to August 2007, 328 patients underwent VATS lobectomy and 413 underwent thoracotomy. There was 1 postoperative death in each group. Survival by Cox model was no different for VATS versus thoracotomy and logistic regression demonstrated fewer complications in the VATS lobectomy group.
Conclusion: VATS lobectomy and thoracotomy demonstrated similar 5-year survival. However, VATS lobectomy was associated with fewer complications and shorter length of hospital stay.
| Patient Characteristics |
| Variable | VATS Lobectomyn=328 | Thoracotomyn=413 | p value |
| Age (mean) | 67 years | 67 years | 0.738 |
| Female Gender | 206(63%) | 266(64%) | 0.652 |
| number of comorbidities | | | 0.142 |
| 1 | 141(43%) | 204 (49%) | |
| 2 | 54 (16%) | 69 (16%) | |
| 3 | 6 (2%) | 13 (3%) | |
| 4 | 1 | 2 | |
| Pathological stage | | | 0.410 |
| IA | 214 (65%) | 260 (63%) | |
| IB | 61 (19%) | 70 (17%) | |
| IIA | 17 (5%) | 19 (5%) | |
| IIB | 9 (3%) | 18 (4%) | |
| IIIA | 21 (6%) | 29 (7%) | |
| IIIB | 6 (3%) | 17 (4%) | |
| Histology | | | 0.072 |
| Adenocarcinoma | 132 (40%) | 149 (36%) | |
| Adeno w/ BAC | 150 (46%) | 174 (53%) | |
| BAC | 4 (1%) | 14 (3%) | |
| Squamous | 35 (11%) | 65 (16%) | |
| Large Cell | 7 (2%) | 11 (3%) | |
| Tumor size (mean) | 2 cm | 2 cm | 0.987 |
| FEV1 % predicted | 92 | 88 | 0.050 |
| Complications | 73 (22%) | 128 (31%) | 0.010 |
| LOS (days) | 5 | 7 | 0.001 |
| 5-year survival (adjusted) | 78% | 76% | 0.080 |
| | | |
| Survival:Cox Model | HR | CI | p value |
| VATS | .67 | .40,1.11 | 0.122 |
| FEV1 | .98 | .97,.99 | 0.008 |
| Tumor Size | 1.34 | 1.14,1.66 | 0.001 |
| Nodal Stage | 3.3 | 1.58,6.71 | 0.001 |
| | | |
| Complications:Logistic Regression | OR | CI | p value |
| Age | 1.04 | 1.02,1.06 | 0.001 |
| VATS | .64 | .45,.89 | 0.010 |
| Tumor Size | 1.20 | 1.03,1.40 | 0.019 |
| | | |
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