Video-assisted thoracic surgery versus open lobectomy for lung cancer: A secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial

Scott, Walter J.; Allen, Mark S.; Darling, Gail; Meyers, Bryan; Decker, Paul A.; Putnam, Joe B.; Mckenna, Robert W.; Landrenau, Rodney J.; Jones, David R.; Inculet, Richard I.; Malthaner, Richard A.

doi:10.1016/j.jtcvs.2009.11.059

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 4 , Pages 976-983, April 2010

Video-assisted thoracic surgery versus open lobectomy for lung cancer: A secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial

Walter J. Scott, MD, FACS
- Fox Chase Cancer Center, Philadelphia, Pa
- Address for reprints: Walter J. Scott, MD, FACS, Fox Chase Cancer Center, Department of Surgical Oncology, 7701 Burholme Avenue, Philadelphia, PA 19111.
Mark S. Allen, MD
- Mayo Clinic, Rochester, Minn
Gail Darling, MD, FRCSC, FACS
- University of Toronto, Toronto, Canada
Bryan Meyers, MD
- Washington University of St Louis, St Louis, Mo
Paul A. Decker, MS
- Mayo Clinic, Rochester, Minn
Joe B. Putnam, MD
- Vanderbilt, University Medical Center, Nashville, Tenn
Robert W. Mckenna, MD
- University of California, Los Angeles, Calif
Rodney J. Landrenau, MD
- Allegheny General Hospital, Pittsburgh, Pa
David R. Jones, MD
- University of Virginia, Charlottesville, Va
Richard I. Inculet, MD
- London Health Science Center, London, Ontario, Canada
Richard A. Malthaner, MD
- London Health Science Center, London, Ontario, Canada

Received 19 June 2009; received in revised form 30 September 2009; accepted 22 November 2009. published online 22 February 2010.

Objective

Video-assisted thoracoscopic lobectomy remains controversial. We compared outcomes from participants in a randomized study comparing lymph node sampling versus dissection for early-stage lung cancer who underwent either video-assisted thoracoscopic or open lobectomy.

Methods

Data from 964 participants in the American College of Surgeons Oncology Group Z0030 trial were used to construct propensity scores for video-assisted thoracoscopic versus open lobectomy (based on age, gender, histology, performance status, tumor location, and T1 vs 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 analysis of variance.

Results

A total of 752 patients (66 video-assisted and 686 open procedures) were analyzed on the basis of propensity score stratification. Median operative time was shorter for video-assisted thoracoscopic lobectomy (video-assisted thoracoscopy 117.5 minutes vs open 171.5 minutes; P < .001). Median total number of lymph nodes retrieved (dissection group only) was similar (video-assisted thoracoscopy 15 nodes vs open 19 nodes; P = .147), as were instances of R1/R2 resection (video-assisted thoracoscopy 0% vs open 2.3%; P = .368). Patients undergoing video-assisted thoracoscopic lobectomy had less atelectasis requiring bronchoscopy (0% vs 6.3%, P = .035), fewer chest tubes draining greater than 7 days (1.5% vs 10.8%; P = .029), and shorter median length of stay (5 days vs 7 days; P < .001). Operative mortality was similar (video-assisted thoracoscopy 0% vs open 1.6%, P = 1.0).

Conclusion

Patients undergoing video-assisted lobectomy had fewer respiratory complications and shorter length of stay. These data suggest video-assisted thoracoscopic lobectomy is safe in patients with resectable lung cancer. Longer follow-up is needed to determine the oncologic equivalency of video-assisted versus open lobectomy.

CTSNet classification: 10, 11, 28

Abbreviations and Acronyms: ACOSOG, American College of Surgeons Oncology Group, CI, confidence interval, NSCLC, non–small cell lung cancer, RR, relative risk, VATS, video-assisted thoracoscopic