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Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer.
J Thorac Cardiovasc Surg. 2009 Jul; 138(1):11-8.JT

Abstract

BACKGROUND

The optimal surgical technique for lobectomy in lung cancer is not well defined. Proponents of video-assisted thoracic surgery (VATS) hypothesize that less trauma leads to quicker recovery, whereas those who advocate thoracotomy claim it as an oncologically superior procedure. However, a well-balanced comparison of the two procedures is lacking in the literature.

METHODS

All patients who underwent lobectomy for clinical stage 1A lung cancer by computed tomographic and positron emission tomographic scan were identified from a prospective database. Patient characteristics were compared by the Student t test, Pearson chi(2), and Fisher exact test. A propensity score-matched analysis was performed. Survival was assessed by Kaplan-Meier and Cox proportional hazards analysis. Complications were assessed by a multivariate logistic regression model evaluating age, sex, comorbidities, pulmonary function, tumor size, nodal status, surgeon, and histologic characteristics.

RESULTS

From May 2002 to August 2007, 398 patients underwent an attempt at VATS lobectomy and 343 underwent thoracotomy. An "intent-to-treat" analysis was performed. There was 1 postoperative death in each group. Survival by Cox model was no different for VATS versus thoracotomy (hazard ratio 0.72; P = .12), whereas age (hazard ratio 1.03; P < .001), larger tumor size (hazard ratio 1.34; P < .001), and higher nodal stage (hazard ratio 1.92; P < .001) were associated with worse survival. Logistic regression demonstrated fewer complications for VATS lobectomy (odds ratio 0.73; P = .06), whereas age (odds ratio 1.04; P < .001) and tumor size (odds ratio 1.2; P < .020) correlated with a greater number of complications. Patients undergoing VATS lobectomy demonstrated a 2-day shorter length of stay than patients undergoing thoracotomy (P < .001). Propensity score-matched analysis supported these findings.

CONCLUSIONS

VATS lobectomy and thoracotomy demonstrated similar 5-year survivals. However, VATS lobectomy was associated with fewer complications and shorter length of hospital stay.

Authors+Show Affiliations

Department of Surgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. floresr@mskcc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19577048

Citation

Flores, Raja M., et al. "Lobectomy By Video-assisted Thoracic Surgery (VATS) Versus Thoracotomy for Lung Cancer." The Journal of Thoracic and Cardiovascular Surgery, vol. 138, no. 1, 2009, pp. 11-8.
Flores RM, Park BJ, Dycoco J, et al. Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2009;138(1):11-8.
Flores, R. M., Park, B. J., Dycoco, J., Aronova, A., Hirth, Y., Rizk, N. P., Bains, M., Downey, R. J., & Rusch, V. W. (2009). Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. The Journal of Thoracic and Cardiovascular Surgery, 138(1), 11-8. https://doi.org/10.1016/j.jtcvs.2009.03.030
Flores RM, et al. Lobectomy By Video-assisted Thoracic Surgery (VATS) Versus Thoracotomy for Lung Cancer. J Thorac Cardiovasc Surg. 2009;138(1):11-8. PubMed PMID: 19577048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. AU - Flores,Raja M, AU - Park,Bernard J, AU - Dycoco,Joseph, AU - Aronova,Anna, AU - Hirth,Yael, AU - Rizk,Nabil P, AU - Bains,Manjit, AU - Downey,Robert J, AU - Rusch,Valerie W, PY - 2008/05/09/received PY - 2009/01/27/revised PY - 2009/03/07/accepted PY - 2009/7/7/entrez PY - 2009/7/7/pubmed PY - 2009/7/29/medline SP - 11 EP - 8 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 138 IS - 1 N2 - BACKGROUND: The optimal surgical technique for lobectomy in lung cancer is not well defined. Proponents of video-assisted thoracic surgery (VATS) hypothesize that less trauma leads to quicker recovery, whereas those who advocate thoracotomy claim it as an oncologically superior procedure. However, a well-balanced comparison of the two procedures is lacking in the literature. METHODS: All patients who underwent lobectomy for clinical stage 1A lung cancer by computed tomographic and positron emission tomographic scan were identified from a prospective database. Patient characteristics were compared by the Student t test, Pearson chi(2), and Fisher exact test. A propensity score-matched analysis was performed. Survival was assessed by Kaplan-Meier and Cox proportional hazards analysis. Complications were assessed by a multivariate logistic regression model evaluating age, sex, comorbidities, pulmonary function, tumor size, nodal status, surgeon, and histologic characteristics. RESULTS: From May 2002 to August 2007, 398 patients underwent an attempt at VATS lobectomy and 343 underwent thoracotomy. An "intent-to-treat" analysis was performed. There was 1 postoperative death in each group. Survival by Cox model was no different for VATS versus thoracotomy (hazard ratio 0.72; P = .12), whereas age (hazard ratio 1.03; P < .001), larger tumor size (hazard ratio 1.34; P < .001), and higher nodal stage (hazard ratio 1.92; P < .001) were associated with worse survival. Logistic regression demonstrated fewer complications for VATS lobectomy (odds ratio 0.73; P = .06), whereas age (odds ratio 1.04; P < .001) and tumor size (odds ratio 1.2; P < .020) correlated with a greater number of complications. Patients undergoing VATS lobectomy demonstrated a 2-day shorter length of stay than patients undergoing thoracotomy (P < .001). Propensity score-matched analysis supported these findings. CONCLUSIONS: VATS lobectomy and thoracotomy demonstrated similar 5-year survivals. However, VATS lobectomy was associated with fewer complications and shorter length of hospital stay. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/19577048/Lobectomy_by_video_assisted_thoracic_surgery__VATS__versus_thoracotomy_for_lung_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(09)00482-6 DB - PRIME DP - Unbound Medicine ER -