Back to 2014 Annual Meeting Posters
Lobectomy by Video-Assisted Thoracic Surgery (VATS) Versus Muscle Sparing Thoracotomy for Stage I Lung Cancer: A Critical Evaluation of Short and Long Term Outcomes
*Anne M Kuritzky, *Bassam I Aswad, *Jason T Machan, Thomas Ng
Brown University, Providence, RI
Objective: Propensity-matched studies have shown lobectomy by VATS to be superior to thoracotomy. However, these studies do not control for institution or surgeon expertise and do not compare VATS strictly with muscle-sparing thoracotomy (MST).
Design: Comparison of two cohorts (VATS vs MST) undergoing lobectomy during the same time period. Data from prospective database derived from a single surgeon experienced with both VATS and MST.
Setting: Academic/Tertiary- care Center
Patients: All patients with clinical stage I non-small cell cancer
Intervention: VATS was chosen if the patient requested this approach, otherwise MST was utilized.
Main Outcome Measures: Short-term (operative characteristics, postoperative complications) and long-term outcomes [disease-free survival (DFS), overall survival (OS)] were compared.
Results: From 2007-2012, 298 patients were evaluated, with 74(25%) VATS and 224(75%) MST. There was no difference in patient demographics, postoperative complications and chest-tube days. Operative time was longer for VATS (median 130min VATS versus 90min MST, p< 0.001). Hospital-days was longer for MST (median 4.5days VATS versus 5days MST, p= 0.007). There was no difference in DFS (5-year 75.5% VATS versus 77.8% MST, p= 0.446) and OS (5-year 80.4% VATS versus 78.9% MST, p= 0.840) for clinical stage I disease. Stratifying for pathologic stage IA and IB, there was no difference in DFS and OS between the two groups.
Conclusions: Our current comparison of VATS versus MST lobectomy, from a single surgeon experienced with both approaches, found operative time (favoring MST) and hospital-days (favoring VATS) to be the only difference between the two groups; while major outcomes such as postoperative complications, DFS and OS were not different. In the absence of a multicenter randomized trial, both approaches for lobectomy should be considered equivalent.
Back to 2014 Annual Meeting Posters
