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Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial.
J Thorac Cardiovasc Surg. 2010 Apr; 139(4):976-81; discussion 981-3.JT

Abstract

OBJECTIVE

Video-assisted thoracoscopic lobectomy remains controversial. We compared outcomes from participants in a randomized study comparing lymph node sampling versus dissection for early-stage lung cancer who underwent either video-assisted thoracoscopic or open lobectomy.

METHODS

Data from 964 participants in the American College of Surgeons Oncology Group Z0030 trial were used to construct propensity scores for video-assisted thoracoscopic versus open lobectomy (based on age, gender, histology, performance status, tumor location, and T1 vs T2). Propensity scores were used to estimate the adjusted risks of short-term outcomes of surgery. Patients were classified into 5 equal-sized groups and compared using conditional logistic regression or repeated measures analysis of variance.

RESULTS

A total of 752 patients (66 video-assisted and 686 open procedures) were analyzed on the basis of propensity score stratification. Median operative time was shorter for video-assisted thoracoscopic lobectomy (video-assisted thoracoscopy 117.5 minutes vs open 171.5 minutes; P < .001). Median total number of lymph nodes retrieved (dissection group only) was similar (video-assisted thoracoscopy 15 nodes vs open 19 nodes; P = .147), as were instances of R1/R2 resection (video-assisted thoracoscopy 0% vs open 2.3%; P = .368). Patients undergoing video-assisted thoracoscopic lobectomy had less atelectasis requiring bronchoscopy (0% vs 6.3%, P = .035), fewer chest tubes draining greater than 7 days (1.5% vs 10.8%; P = .029), and shorter median length of stay (5 days vs 7 days; P < .001). Operative mortality was similar (video-assisted thoracoscopy 0% vs open 1.6%, P = 1.0).

CONCLUSION

Patients undergoing video-assisted lobectomy had fewer respiratory complications and shorter length of stay. These data suggest video-assisted thoracoscopic lobectomy is safe in patients with resectable lung cancer. Longer follow-up is needed to determine the oncologic equivalency of video-assisted versus open lobectomy.

Authors+Show Affiliations

Fox Chase Cancer Center, Department of Surgical Oncology, 7701 Burholme Avenue, Philadelphia, PA 19111, USA. walter.scott@fccc.eduNo affiliation info availableNo affiliation info availableNo 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)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20172539

Citation

Scott, Walter J., et al. "Video-assisted Thoracic Surgery Versus Open Lobectomy for Lung Cancer: a Secondary Analysis of Data From the American College of Surgeons Oncology Group Z0030 Randomized Clinical Trial." The Journal of Thoracic and Cardiovascular Surgery, vol. 139, no. 4, 2010, pp. 976-81; discussion 981-3.
Scott WJ, Allen MS, Darling G, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;139(4):976-81; discussion 981-3.
Scott, W. J., Allen, M. S., Darling, G., Meyers, B., Decker, P. A., Putnam, J. B., McKenna, R. W., Landrenau, R. J., Jones, D. R., Inculet, R. I., & Malthaner, R. A. (2010). Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. The Journal of Thoracic and Cardiovascular Surgery, 139(4), 976-81; discussion 981-3. https://doi.org/10.1016/j.jtcvs.2009.11.059
Scott WJ, et al. Video-assisted Thoracic Surgery Versus Open Lobectomy for Lung Cancer: a Secondary Analysis of Data From the American College of Surgeons Oncology Group Z0030 Randomized Clinical Trial. J Thorac Cardiovasc Surg. 2010;139(4):976-81; discussion 981-3. PubMed PMID: 20172539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. AU - Scott,Walter J, AU - Allen,Mark S, AU - Darling,Gail, AU - Meyers,Bryan, AU - Decker,Paul A, AU - Putnam,Joe B, AU - McKenna,Robert W, AU - Landrenau,Rodney J, AU - Jones,David R, AU - Inculet,Richard I, AU - Malthaner,Richard A, Y1 - 2010/02/20/ PY - 2009/06/19/received PY - 2009/09/30/revised PY - 2009/11/22/accepted PY - 2010/2/23/entrez PY - 2010/2/23/pubmed PY - 2010/5/13/medline SP - 976-81; discussion 981-3 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 139 IS - 4 N2 - OBJECTIVE: Video-assisted thoracoscopic lobectomy remains controversial. We compared outcomes from participants in a randomized study comparing lymph node sampling versus dissection for early-stage lung cancer who underwent either video-assisted thoracoscopic or open lobectomy. METHODS: Data from 964 participants in the American College of Surgeons Oncology Group Z0030 trial were used to construct propensity scores for video-assisted thoracoscopic versus open lobectomy (based on age, gender, histology, performance status, tumor location, and T1 vs T2). Propensity scores were used to estimate the adjusted risks of short-term outcomes of surgery. Patients were classified into 5 equal-sized groups and compared using conditional logistic regression or repeated measures analysis of variance. RESULTS: A total of 752 patients (66 video-assisted and 686 open procedures) were analyzed on the basis of propensity score stratification. Median operative time was shorter for video-assisted thoracoscopic lobectomy (video-assisted thoracoscopy 117.5 minutes vs open 171.5 minutes; P < .001). Median total number of lymph nodes retrieved (dissection group only) was similar (video-assisted thoracoscopy 15 nodes vs open 19 nodes; P = .147), as were instances of R1/R2 resection (video-assisted thoracoscopy 0% vs open 2.3%; P = .368). Patients undergoing video-assisted thoracoscopic lobectomy had less atelectasis requiring bronchoscopy (0% vs 6.3%, P = .035), fewer chest tubes draining greater than 7 days (1.5% vs 10.8%; P = .029), and shorter median length of stay (5 days vs 7 days; P < .001). Operative mortality was similar (video-assisted thoracoscopy 0% vs open 1.6%, P = 1.0). CONCLUSION: Patients undergoing video-assisted lobectomy had fewer respiratory complications and shorter length of stay. These data suggest video-assisted thoracoscopic lobectomy is safe in patients with resectable lung cancer. Longer follow-up is needed to determine the oncologic equivalency of video-assisted versus open lobectomy. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/20172539/Video_assisted_thoracic_surgery_versus_open_lobectomy_for_lung_cancer:_a_secondary_analysis_of_data_from_the_American_College_of_Surgeons_Oncology_Group_Z0030_randomized_clinical_trial_ DB - PRIME DP - Unbound Medicine ER -