Lobectomy by Video-Assisted Thoracic Surgery vs Muscle-Sparing Thoracotomy for Stage I Lung Cancer: A Critical Evaluation of Short- and Long-Term Outcomes.

BACKGROUND: 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).

STUDY DESIGN: From a single surgeon experienced in both VATS and MST, patients undergoing lobectomy for clinical stage I non-small cell cancer were evaluated. Video-assisted thoracic surgery was chosen if the patient requested this approach, otherwise MST was used. Short-term and long-term outcomes were compared.

RESULTS: From 2007 to 2012, two hundred and ninety-eight patients were evaluated, 74 (25%) VATS and 224 (75%) MST. There were no statistically significant differences in demographics, chest tube days, and postoperative complications between the 2 surgical groups. Operative time was longer for VATS (median 130 minutes for VATS vs 90 minutes for MST; p<0.001). Hospital length of stay was longer for MST (median 4.5 days for VATS vs 5 days for MST; p=0.007). There was no difference in disease-free survival (5-year: 76% for VATS vs 78% for MST; p=0.446) and overall survival (5-year: 80% for VATS vs 79% for MST; p=0.840) for clinical stage I disease. Results were unchanged using propensity score matching of 60 VATS and 60 MST patients for postoperative complications, disease-free survival, and overall survival between the 2 matched groups.

CONCLUSIONS: Our current comparison of VATS vs MST, 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 2 groups; and major outcomes, such as postoperative complications, disease-free survival, and overall survival, were not different. A multi-institution randomized trial should be considered before deeming any one approach to be superior.