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OBJECTIVE: Video-assisted thoracoscopic lobectomy (VATS) has been reported to provide superior outcomes compared to open lobectomy for patients with early-stage non-small cell lung carcinoma (NSCLC). However, advantages of VATS or open thoracotomy remain controversial. The aim of this study was to compare preoperative, operative and postoperative characteristics for patients with NSCLC who underwent VATS or open lobectomy.
METHODS: 91 operable patients with NSCLC were studied from October 2009 to October 2011. All surgery was performed by a single surgeon. Patients that underwent lobectomy with chest wall resection were excluded from the study. All patients apart from those with small (<2 cm) peripheral lung lesions on computed tomography (CT) of the chest underwent positron-emission tomography-computed tomography (PET-CT). Patients after neo-adjuvant chemotherapy, patients with previous thoracotomy, and patients with central lung tumors or with N1 disease on PET-CT were operated by open lobectomy. Others with peripheral lesions or larger T2 non-central lesions underwent VATS lobectomy. The age, gender, preoperative co-morbidities, intraoperative complications, hospital stay, Charlson score, postoperative complications, morbidity, mortality and other characteristics were statistically compared. Univariate analysis and logistic regression analysis were performed to compare all these characteristics or to identify risks of short-term outcomes of surgery by VATS or open methods.
RESULTS: 54 VATS lobectomies and 37 open lobectomies were performed. After VATS lobectomy 33 (61.8%) patients had no complications compared with 23 (62.5%) who underwent open lobectomy. Compared with VATS lobectomy, the patients operated with open lobectomy were significantly younger (66.4±8.4 vs 70.6±8.3; p=0.02). Univariate analysis of variance revealed that hospital stay is predicted by smoking and chronic atrial fibrillation, but not by type of surgery. Logistic regression analysis showed that type of surgery is not associated with death even after adjusting for other variables including smoking, chronic atrial fibrillation and age. There were no significant differences when comparing other characteristics, but further investigation is continuing to support or change the results of this pilot study.
CONCLUSIONS: Our initial data suggests that VATS lobectomy is safe in patients with resectable IA/IB lung cancer and may be the preferred strategy of treatment for the older patient population.