Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer

Dong Xie; Jiajun Deng; Diego Gonzalez-Rivas; Yuming Zhu; Lei Jiang; Gening Jiang; Chang Chen

doi:10.1016/j.jtcvs.2020.01.105

Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer

J Thorac Cardiovasc Surg. 2021 Feb;161(2):403-413.e2. doi: 10.1016/j.jtcvs.2020.01.105. Epub 2020 Mar 25.

Authors

Dong Xie¹, Jiajun Deng¹, Diego Gonzalez-Rivas², Yuming Zhu¹, Lei Jiang¹, Gening Jiang¹, Chang Chen³

Affiliations

¹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
³ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China. Electronic address: chenthoracic@163.com.

PMID: 32386762
DOI: 10.1016/j.jtcvs.2020.01.105

Abstract

Objectives: The aim of this study was to investigate the adequacy of bronchial sleeve lobectomy by video-assisted thoracoscopic surgery in perioperative outcomes and its oncological efficacy by comparing with thoracotomy in a balanced population.

Methods: A total of 363 patients who received bronchial sleeve lobectomy for non-small cell lung cancer from January 2013 to December 2017 were included and placed in the thoracotomy (n = 251) and video-assisted thoracoscopic surgery (n = 112) groups. Statistical analyses were performed to compare patients' demographics, perioperative outcomes, and survival between the 2 groups.

Results: A total of 116 thoracotomy cases were matched with 72 video-assisted thoracoscopic surgery cases by propensity score. Compared with thoracotomy, patients in the video-assisted thoracoscopic surgery group after matching had less intraoperative blood loss (P < .01) and length of postoperative hospital stay (P < .01), duration of chest tube drainage (P < .01), and intensive care unit stay (P = .03) despite comparable operative time, complication rate, and 30- to 90-day mortality rate. The overall survival and recurrence-free survival were similar in patients who received sleeve lobectomy by thoracotomy and video-assisted thoracoscopic surgery (log-rank, P = .24 and .20, respectively) at 3 years. Although advanced TNM stage was independently associated with worse overall survival and recurrence-free survival in multivariable analysis, older age was only predictive for worse overall survival (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .02). Body mass index was also found be a predictive factor (overall survival: hazard ratio, 0.93; 95% confidence interval, 0.86-0.99, P = .03; recurrence-free survival: hazard ratio, 0.93; 95% confidence interval, 0.87-0.99, P = .02).

Conclusions: With appropriate patient selection and continued experience, video-assisted thoracoscopic surgery appears to be safe in the short-term perioperative period and does not appear to comprise oncologic outcomes in performing sleeve lobectomy.

Keywords: lung cancer; sleeve lobectomy; video-assisted thoracoscopic surgery.

Publication types

Comparative Study

MeSH terms

Adult
Aged
Aged, 80 and over
Blood Loss, Surgical / statistics & numerical data
Carcinoma, Non-Small-Cell Lung / mortality
Carcinoma, Non-Small-Cell Lung / surgery*
Female
Humans
Length of Stay / statistics & numerical data
Lung Neoplasms / mortality
Lung Neoplasms / surgery*
Male
Middle Aged
Pneumonectomy / methods*
Pneumonectomy / mortality
Retrospective Studies
Survival Analysis
Thoracic Surgery, Video-Assisted* / methods
Thoracic Surgery, Video-Assisted* / mortality
Thoracotomy* / methods
Thoracotomy* / mortality
Treatment Outcome