High Risk for Thoracotomy but not Thoracoscopic Lobectomy.

BACKGROUND: Pulmonary lobectomy is the standard of care for resection of non-small cell lung cancer (NSCLC). Patients with compromised lung function who are considered high risk may be denied surgical treatment; thus, proper identification of those truly at high risk is critical. Video-assisted thoracic surgery (VATS) may reduce the operative risk. This study reviews our institutional experience of pulmonary lobectomy by open thoracotomy or VATS techniques in patients deemed to be high risk. METHODS: A retrospective review of an institutional database was performed for all patients undergoing lobectomy from 2002 to 2010. Patients were grouped into high-risk (HR) and standard-risk (SR) cohorts according to the American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021 criteria. RESULTS: From 2002 to 2010, 72 HR and 536 SR patients underwent lobectomy. Mean age was 73 years for HR and 66 years for SR (p < 0.0001). Rates of overall (p < 0.0001) and pulmonary complications (p < 0.0001) were significantly higher in the HR group. However, when HR patients were resected by VATS, there was no significant difference in overall (p = 0.1299) or pulmonary complications (p = 0.2292) compared with the SR VATS group. Moreover, overall survival was significantly lower for HR patients who had an open operation compared with VATS lobectomy or SR open (p = 0.0028). CONCLUSIONS: VATS lobectomy offers patients who are considered to be at increased risk for open lobectomy a feasible procedure, with no difference in overall survival compared with SR patients, and decreased morbidity compared with open lobectomy. VATS lobectomy should be considered for patients who historically may not have been considered for surgical resection.

Is video-assisted lobectomy for non-small-cell lung cancer oncologically equivalent to open lobectomy?

OBJECTIVES: The purpose of this study was to compare overall and disease-free survival after VATS and open lobectomy for clinical Stage I and II non-small-cell lung cancer (NSCLC). METHODS: A retrospective review of a prospective database of all patients undergoing VATS or open lobectomy for clinical Stage I or II NSCLC between 2002 and 2010 was performed. Postoperative outcomes, disease-free survival and overall survival were compared between the two groups after optimum 1:1 propensity matching for age, gender, tumour histology and pathological stage. RESULTS: Over an 8-year period, 608 patients underwent lobectomy for NCSLC by VATS (n = 196, 32%) or open technique (n = 412, 68%). After matching, there were 190 patients in each group. Adenocarcinoma was found in 80% (open: 149, VATS: 152) and 55% of tumours were T1 (open: 108, VATS: 105). Pathological N1 disease was found in 21 and 19 patients in the open and VATS group, respectively. Disease-free 5-year survival was 69.1% for the open group vs 69.7% for VATS (P = 0.94). Cancer-specific 5-year survival was 82.9% for the open group vs 76.7% for VATS (P = 0.170). Five-year overall survival was 73% in the open group vs 64% in the VATS group (P = 0.17). Operative mortality and postoperative complications were not significantly different between groups. CONCLUSIONS: Overall survival and disease-free survival are not significantly different when compared between VATS lobectomy and open lobectomy. VATS resection appears to provide an adequate oncological operation for patients with operable clinical Stage I and II NSCLC.