Comparison of the Short- and Long-term Outcomes of Video-assisted Thoracoscopic Surgery versus Open Thoracotomy Bronchia
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Comparison of the Short- and Long-term Outcomes of Videoassisted Thoracoscopic Surgery versus Open Thoracotomy Bronchial Sleeve Lobectomy for Central Lung Cancer: A Retrospective Propensity Score Matched Cohort Study Yanbo Yang, MD1,2, Jiandong Mei, MD1,2, Feng Lin, MD1,2, Qiang Pu, MD1,2, Lin Ma, MD1,2, Chengwu Liu, MD1,2, Yunke Zhu, MD1,2, Chenglin Guo, MD1,2, Liang Xia, MD1,2, and Lunxu Liu, MD Ph.D1 1
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan , People’s Republic of China; 2Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
ABSTRACT Purpose. The purpose of this study was to evaluate the short- and long-term outcomes of video-assisted thoracoscopic surgery (VATS) versus open thoracotomy bronchial sleeve lobectomy (BSL) for patients with central lung cancer. Methods. This is a retrospective cohort study. Perioperative outcomes and long-term survival of patients who underwent VATS versus open thoracotomy BSL for central lung cancer from June 2010 and June 2018 in the Western China Lung Cancer Database were compared using propensity score matching (PSM) between the two surgical approaches. Results. The retrospective study included 187 patients who divided into VATS group (n = 44) and open group (n = 143) according to surgical approach, and PSM resulted in 43 patients in each group, which were well matched by 11 potential prognostic factors. The VATS group was associated with lower overall incidence of postoperative complications (20.3% vs. 30.2%, P = 0.029), less postoperative drainage (875 ml [250–3960] vs. 1280 ml
Yanbo Yang and Jiandong Mei have contributed equally to this work. Ó Society of Surgical Oncology 2020 First Received: 15 December 2019 Accepted: 25 May 2020 L. Liu, MD Ph.D e-mail: [email protected]
[100–4890], P = 0.039). The 5-year overall survival (OS) and disease-free survival (DFS) were comparable between the VATS and open groups (55.9% vs. 65.2% P = 0.836 and 54.1% vs. 60.2% P = 0.391, respectively) after matching. Multivariable adjusted analysis demonstrated that the surgical approach was not an independent favorable prognostic factor for OS (hazard ratio [HR] = 0.922; 95% confidence interval [CI], 0.427-1.993; P = 0.836) but just the pTNM stage (HR = 2.003; 95% CI 1.187–3.382; P = 0.009). Conclusions. VATS BSL may achieve equivalent longterm outcomes for central lung cancer patients when comparing with open thoracotomy. Although slightly longer duration of surgery, VATS approach may be a feasible option for lung cancer patients requiring BSL.
Bronchial sleeve lobectomy (BSL) was first reported by Clement Price Thomas as a lung-sparing operation for a patient with carcinoid tumor in 1947.1 Subsequently, sleeve lobectomy (SL), which is oncologically comparable to pneumonectomy with the advantage of preserving more pulmonary function and decreasing morbidity and mortality, is considered to be a safe and feasible
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