Background: There are concerns over procedure-related pleural dissemination during video-assisted thoracic surgery (VATS) lobectomy. We compared the incidence of pleural recurrence and long-term survival between patients undergoing thoracotomy and VATS lobectomy for non-small cell lung cancer (NSCLC) with visceral pleural invasion.
Methods: From 2004 to 2009, 2,774 patients underwent curative-intent pulmonary resection for NSCLC at our institution. Of those, 478 patients were pathologically confirmed to have visceral pleural invasion by primary tumor. Among these, 239 patients (50%) underwent VATS lobectomy and 239 (50%) underwent thoracotomy lobectomy. Their medical records were retrospectively reviewed and a propensity score-matched analysis was performed.
Results: Matching based on propensity scores produced 167 patients in each group. There were no significant differences between two groups in age, sex, histologic type, tumor size, and pathologic N stage. The median follow-up duration was 52 months. During follow-up, 14 patients (8.4%) from the VATS group and 12 (7.2%) from the thoracotomy group had ipsilateral pleural recurrence (p = 0.735). There was no significant difference in the recurrence pattern between the two groups. Overall survival at 5 years was 83% and 74% in the VATS and thoracotomy groups, respectively (p = 0.16). Disease-free survival at 5 years was 65% and 62% in the VATS and thoracotomy groups, respectively (p = 0.45).
Conclusions: Compared with thoracotomy, VATS lobectomy does not seem to increase the risk of procedure-related pleural dissemination in patients with NSCLC with visceral pleural invasion. Long-term survival and pattern of recurrence were similar between the two groups.
Keywords: 10.
Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.