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Comparative Study
. 2014 Oct 2:349:g5575.
doi: 10.1136/bmj.g5575.

Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database

Subroto Paul  1 , Abby J Isaacs  2 , Tom Treasure  3 , Nasser K Altorki  4 , Art Sedrakyan  5
Affiliations
Comparative Study

Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database

Subroto Paul et al. BMJ. .

Abstract

Objective: To compare long term survival after minimally invasive lobectomy and thoracotomy lobectomy.

Design: Propensity matched analysis.

Setting: Surveillance, Epidemiology and End Results (SEER)-Medicare database.

Participants: All patients with lung cancer from 2007 to 2009 undergoing lobectomy.

Main outcome measure: Influence of less invasive thoracoscopic surgery on overall survival, disease-free survival, and cancer specific survival.

Results: From 2007 to 2009, 6008 patients undergoing lobectomy were identified (n=4715 (78%) thoracotomy). The median age of the entire cohort was 74 (interquartile range 70-78) years. The median length of follow-up for entire group was 40 months. In a matched analysis of 1195 patients in each treatment category, no statistical differences in three year overall survival, disease-free survival, or cancer specific survival were found between the groups (overall survival: 70.6% v 68.1%, P=0.55; disease-free survival: 86.2% v 85.4%, P=0.46; cancer specific survival: 92% v 89.5%, P=0.05).

Conclusion: This propensity matched analysis showed that patients undergoing thoracoscopic lobectomy had similar overall, cancer specific, and disease-free survival compared with patients undergoing thoracotomy lobectomy. Thoracoscopic techniques do not seem to compromise these measures of outcome after lobectomy.

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Conflict of interest statement

Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: AS received funding from the US FDA for establishing the MDEpiNet Science and Infrastructure Centre; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Patient selection flow chart. HMO=health maintenance organization; NSCLC=non-small cell lung cancer; SEER=Surveillance, Epidemiology and End Results
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Fig 2 Kaplan-Meier survival plots (time until death with number of participants at risk) for thoracoscopic and thoracotomy lobectomy in unmatched (left side) and matched (right side) samples
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Fig 3 Cox proportional hazards models for all cause mortality, disease specific mortality, and disease recurrence in matched and unmatched samples
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