Video-Assisted Vs Thoracotomy Sleeve Lobectomy for Lung Cancer: A Propensity Matched Analysis

Ann Thorac Surg. 2019 Oct;108(4):1072-1079. doi: 10.1016/j.athoracsur.2019.04.037. Epub 2019 Jun 1.


Background: In this retrospective study, we evaluated the safety and efficacy of video-assisted thoracic surgery (VATS) sleeve lobectomy for patients with centrally located non-small cell lung cancer.

Methods: All consecutive patients who received VATS sleeve lobectomy (n = 54) and thoracotomy sleeve lobectomy (n = 94) were analyzed retrospectively; after propensity score matching, 78 paired cases were selected for further statistical analysis.

Results: Among all patients, the VATS group showed significantly better recurrence-free survival and overall survival than the thoracotomy group (P = .025 and P = .026, respectively) with smaller total tumor size and earlier pathological tumor-node-metastasis (TNM) stage. Nevertheless, after matching, the recurrence-free survival (50.9% vs 48.7%; P = .445) and overall survival (79.5% vs 66.7%; P = .198) were not significantly different. There was significantly less blood loss (228 vs 246 mL; P = .022), shorter thoracic drainage stay (4.6 vs 6.8 days; P < .001), and postoperative hospital stay (9.2 vs 11.3 days; P = .033) in the VATS group. Multivariate Cox analyses demonstrated that the surgical procedure was not an independent prognostic factor for recurrence-free survival, not only for patients with an invasive component size of 3 cm or less and negative lymphatic invasion, but for locally advanced patients with an invasive tumor size >3 cm (hazard ratio: 0.94; 95% confidence interval: 0.36-2.45; P = .55) or positive lymphatic invasion (hazard ratio: 0.91; 95% confidence interval: 0.35-2.39; P = .41).

Conclusions: VATS sleeve lobectomy is a safe and effective procedure associated with better postoperative recovery and equivalent oncological results, even for locally advanced non-small cell lung cancer patients with an invasive tumor size larger than 3 cm or accompanying lymphatic invasion.

MeSH terms

  • Bronchi
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Female
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pneumonectomy / methods*
  • Propensity Score*
  • Retrospective Studies
  • Thoracic Surgery, Video-Assisted / methods*
  • Thoracotomy / methods*
  • Tomography, X-Ray Computed
  • Treatment Outcome