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Objective:
In North America, open lobectomy continues to be more commonly performed than VATS lobectomy. We have previously described the short-term safety of an approach for transitioning from open lobectomy to VATS. We now asses its long-term safety by evaluating the survival results of the initial VATS cases after the transition.
Design:
Cohort study, prospective database
Setting:
Tertiary-care center
Patients:
Stage I non-small cell lung cancer
Interventions:
First 40 VATS lobectomy was compared with the 40 open lobectomy performed just prior the transitioning to VATS. Open lobectomy was performed with lateral muscle sparing incision. VATS was performed with 5cm non-rib spreading incision along with 2 or 3 thoracic ports.
Main Outcome Measures:
Disease-free and overall survival
Results:
Patient demographics and intraoperative characteristics were not different between the two groups, except for operative time, which was longer for VATS (median 132 vs 150 min, p= 0.023). There was no difference in specific complication rates and overall morbidity. Four VATS patients required conversion to open; three for control of pulmonary artery bleeding and one due to adhesions. Median follow-up was 118 months for the open group and 81 months for the VATS group. The 5-year disease-free survival for stage IA (90% Open vs 97% VATS, p= 0.439) and IB (74% Open vs 79% VATS, p= 0.478) were not different. The 5-year overall survival for stage IA (91% Open vs 97% VATS, p= 0.152) and IB (55% Open vs 67% VATS, p= 0.198) were also not different.
Conclusions:
The transition from open to VATS lobectomy is safe with regards to both short-term morbidity and long-term survival. Current surgeons performing open lobectomy should consider transitioning to the VATS procedure.