Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA.
Ann Surg. 2019 Jan;269(1):163-171. doi: 10.1097/SLA.0000000000002342.
The objective of this study was to compare the long-term survival of open versus thoracoscopic (VATS) lobectomy for early stage non-small-cell lung cancer (NSCLC).
Data from national studies on long-term survival for VATS versus open lobectomy are limited.
Outcomes of patients who underwent open versus VATS lobectomy for clinical T1-2, N0, M0 NSCLC in the National Cancer Data Base were evaluated using propensity score matching.
The median follow-up of 7114 lobectomies (5566 open and 1548 VATS) was 52.0 months. The VATS approach was associated with a better 5-year survival when compared to the open approach (66.0% vs. 62.5%, P = 0.026). Propensity score matching resulted in 1464 open and 1464 VATS patients who were well matched by 14 common prognostic covariates including tumor size and comorbidities. After propensity score matching, the VATS approach was associated with a shorter median length of stay (5 vs. 6 days, P < 0.001). The VATS approach was not significantly different compared with the open approach with regard to nodal upstaging (11.6% vs 12.3%, P = 0.53), 30-day mortality (1.7% vs 2.3%, P = 0.50) and 5-year survival (66.3% vs 65.8%, P = 0.92).
In this national analysis, VATS lobectomy was used in the minority of patients with stage I NSCLC. VATS lobectomy was associated with shorter length of stay and noninferior long-term survival when compared with open lobectomy. These results support previous findings from smaller single- and multi-institutional studies that suggest that VATS does not compromise oncologic outcomes when used for early-stage lung cancer and suggest the need for broader implementation of VATS techniques.
本研究旨在比较开胸肺叶切除术（VATS）与电视辅助胸腔镜手术（VATS）治疗早期非小细胞肺癌（NSCLC）的长期生存率。
VATS 与开胸肺叶切除术长期生存数据的国家研究有限。
采用倾向评分匹配法评估国家癌症数据库中接受 VATS 与开胸肺叶切除术治疗临床 T1-2、N0、M0 NSCLC 患者的结局。
7114 例肺叶切除术（5566 例开胸和 1548 例 VATS）的中位随访时间为 52.0 个月。与开胸手术相比，VATS 方法的 5 年生存率更高（66.0% vs. 62.5%，P = 0.026）。倾向评分匹配后，1464 例开胸和 1464 例 VATS 患者通过 14 个常见预后协变量（包括肿瘤大小和合并症）进行了很好的匹配。倾向评分匹配后，VATS 组的中位住院时间更短（5 天 vs. 6 天，P < 0.001）。与开胸手术相比，VATS 组淋巴结分期升高（11.6% vs. 12.3%，P = 0.53）、30 天死亡率（1.7% vs. 2.3%，P = 0.50）和 5 年生存率（66.3% vs. 65.8%，P = 0.92）无显著差异。
在这项全国性分析中，VATS 肺叶切除术仅用于少数 I 期 NSCLC 患者。与开胸肺叶切除术相比，VATS 肺叶切除术具有较短的住院时间和非劣效的长期生存率。这些结果支持了来自单中心和多中心的小型研究的先前发现，即 VATS 用于早期肺癌不会影响肿瘤学结果，并表明需要更广泛地应用 VATS 技术。
