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Ann Surg. 2017 Aug 9. doi: 10.1097/SLA.0000000000002342. [Epub ahead of print]

A National Analysis of Long-term Survival Following Thoracoscopic Versus Open Lobectomy for Stage I Non-small-cell Lung Cancer.

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1
*Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC †Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA.

Abstract

OBJECTIVE:

The objective of this study was to compare the long-term survival of open versus thoracoscopic (VATS) lobectomy for early stage non-small-cell lung cancer (NSCLC).

BACKGROUND:

Data from national studies on long-term survival for VATS versus open lobectomy are limited.

METHODS:

Outcomes of patients who underwent open versus VATS lobectomy for clinical T1-2, N0, M0 NSCLC in the National Cancer Data Base were evaluated using propensity score matching.

RESULTS:

The median follow-up of 7114 lobectomies (5566 open and 1548 VATS) was 52.0 months. Propensity score matching resulted in 1464 open and 1464 VATS patients who were well-matched by 14 common prognostic covariates including tumor size and comorbidities. The VATS approach was associated with a shorter median length of stay (5 vs. 6 days, P < 0.001) and better 5-year survival (66.0% vs. 62.5%, P = 0.026), and was not significantly different compared with the open approach with regard to nodal upstaging (11.2% vs. 12.5%, P = 0.46), and 30-day mortality (1.7% vs. 2.5%, P = 0.14). In the propensity-matched analysis of 2928 patients, there were no significant differences in 5-year survival between the VATS and open groups (66.3% vs. 65.8%, P = 0.92).

CONCLUSIONS:

In this national analysis, VATS lobectomy was used in the minority of patients with stage I NSCLC. VATS lobectomy was associated with shorter length of stay and noninferior long-term survival when compared with open lobectomy. These results support previous findings from smaller single- and multi-institutional studies that suggest that VATS does not compromise oncologic outcomes when used for early-stage lung cancer and suggest the need for broader implementation of VATS techniques.

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