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Perioperative Outcomes of Video-Assisted (VATS) Resection for Lung Cancer Compared to Open Thoracotomy: An Analysis of Data from the American College of Surgeons Oncology Group (ACOSOG) Z0030 Clinical Trial
Walter Scott1, Mark Allen2, Bryan Meyers3, Paul Decker2, Joe B Putnam4
1Fox Chase Cancer Center, Philadelphia, PA;2Mayo Clinic, Rochester, MN;3Washington University of St. Louis, St. Louis, MO;4Vanderbilt University, Nashville, TN
Background: The benefits of VATS lobectomy compared to thoracotomy and open lobectomy remain controversial. We compared the perioperative short term outcomes from participants that were enrolled in a randomized trial comparing lymph node sampling versus mediastinal lymph node dissection for early stage lung cancer who underwent either VATS lobectomy or thoracotomy and open lobectomy.
Methods: Prospectively collected data were analyzed from 964 patients who underwent lobectomy, segmentectomy and bilobectomy as participants in ACOSOG Z0030. A propensity score for choice of treatment approach (VATS versus open) was constructed from clinical and tumor characteristics (age, gender, histology, performance status, tumor location, and T1 versus T2). Propensity scores were used to estimate the adjusted risks of short term outcomes of surgery. Patients were classified into 5 equal-sized groups and compared using conditional logistic regression or repeated measures ANOVA. Two-sided p-values <0.05 were considered statistically significant.
Results: 752 patients (66 VATS and 686 open) were included in the analysis based on the propensity score stratificationwere. Perioperative outcomes are shown in Table 1.
Conclusions: After adjusting for preoperative differences between groups using propensity scoring, patients undergoing VATS resection experienced fewer serious respiratory complications, earlier removal of chest tubes and shorter length of stay than patients undergoing open thoracotomy and resection. These data support the assessment of VATS lobectomy as safe in patients with resectable lung cancer. Long term follow-up data are needed to determine oncologic equivalency of VATS compared to open lobectomy.
Table 1.Values are median; range unless specified by n (%)| Perioperative Outcome | VATS (n=66) | Open (n=686) | P | | Operative time, minutes | 117.5; 61-450 | 171.5; 40-425 | <0.001 | | Lymph nodes retrieved | 15; 5-48 | 19; 2-83 | 0.147 | | R1/R2 resection, n (%) | 0 (0) | 16 (2.3) | 0.368 | | Chest tube drainage >7 days, n (%) | 1 (1.5) | 74 (10.8) | 0.029 | | Atelectasis requiring bronchoscopy, n (%) | 0 (0) | 43 (6.3) | 0.035 | | Chest tube duration, days | 3; 0-25 | 5; 1-36 | <0.001 | | Chest tube drainage, ml | 987; 140-3382 | 1504.5; 8-25139 | 0.001 | | Hospital length of stay, n (%) | 4.5; 1-19 | 7; 0-99 | <0.001 | | Operative mortality, n (%) | 0 (0) | 11 (1.6) | 1.0 |
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