Long-term Outcome of Video-assisted Thoracoscopic Surgery Versus Thoracotomy for Pathological N1 Stage Non-small Cell Lung Cancer

Hyeong ryul Kim, Su Kyung Hwang, Se Hoon Choi, Yong Hee Kim, Dong Kwan Kim, Seung-Il Park

Asan Medical Center, Seoul, Korea (South)

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–C

Abstract

Background : Application of video-assisted thoracoscopic surgery (VATS) has not been evaluated in advanced stage non-small cell lung cancer. We compared the oncologic outcomes between VATS and open thoracotomy retrospectively, by using propensity score matching.

Methods : We evaluated 276 consecutive patients who underwent lung resection surgery for pathologic N1 stage non-small cell lung cancer between January 2000 and December 2011 via a retrospective chart review. We used a propensity score matching analysis for comparing VATS and thoracotomy except clinical T3 and T4 stage patients (based on age, sex, smoking, FEV1,DLco, and clincal T stage).

Results : We performed open thoracotomy in 218 patients and VATS in 58 patients. Patient’s demographics were similar between VATS and thoracotomy. However, VATS patients had smaller tumor size than open group. (Clinical T1 stage, p=0.012). The difference in the 5-year survival rate for the pathological stage was not statistically significant between the video-assisted thoracoscopic and thoracotomy groups (pT1; 62.9% vs. 37.6%, p=0.449, pT2; 58.3% vs. 57.6%, p=0.700, pT3; 37.5% vs. 53.3%, p=0.413). The 5-year disease-free survival rate was also similar between the two groups (pT1; 42.8% vs. 58.5%, p=0.985, pT2; 55.7% vs. 57.0%, p=0.885, pT3; 53.4% vs. 62.8%, p=0.367). The propensity matching group is in 156 patients (46 VATS and 110 thoracotomy). Median operative time and median total number of lymph nodes retrieved was similar between two groups (p=0.605, p=0.086). However, the hospital stay duration and the chest tube indwelling time were significantly shorter in the VATS group compared to in the open group.

Conclusion : VATS for patients with pathological N1 stage non-small cell lung cancer appears to have long-term outcomes of survival and recurrence similar to those with thoracotomy. Therefore, VATS is a feasible approach for patients with pathological N1 stage non-small cell lung cancer.