Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: a meta-analysis

Eur J Cardiothorac Surg. 2013 Oct;44(4):591-7. doi: 10.1093/ejcts/ezt051. Epub 2013 Feb 14.


Video-assisted thoracic surgery (VATS) lobectomy is an appealing alternative to open lobectomy via thoracotomy for non-small-cell lung cancer. However, there is no clear consensus in regard to the superior approach for long-term outcomes. The data are limited to small series, which precludes further clarification. Meta-analysis of these studies was performed in order to obtain a more objective determination of the oncological feasibility of VATS lobectomy. A systematic review of the PubMed and Embase databases was performed. Twenty observational studies reporting long-term outcomes were included, involving 2106 VATS and 2661 thoracotomy patients. There was an advantage in long-term mortality for patients who underwent VATS vs patients who underwent thoracotomy (meta difference in survival: 5%; 95% CI: 3-6%) with large heterogeneity among studies (Q = 42.6; P-value: 0.001; I(2) = 55.7%). There was no evidence of publication bias. Compared with open lobectomy, VATS lobectomy appears to have improved long-term outcomes.

Keywords: Lung cancer; NSCLC; Open lobectomy; Thoracic surgery; Thoracotomy; VATS lobectomy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Humans
  • Lung Neoplasms / surgery*
  • Pneumonectomy*
  • Thoracic Surgery, Video-Assisted*
  • Thoracotomy