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Results of video-assisted thoracic surgery versus thoracotomy in surgical resection of pN2 non-small cell lung cancer in a Chinese high-volume Center

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Abstract

Purpose

To investigate the short-term outcomes and long-term oncological efficacy of video-assisted thoracic surgery (VATS) for surgical treatment of pN2 non-small cell lung cancer (NSCLC) compared with open thoracotomy (OT).

Patients and methods

We retrospectively collected data from 1034 patients who underwent pulmonary resection and systemic lymph node dissection for pathological N2 NSCLC from September 2005 to December 2017 (536 patients in VATS group and 498 patients in OT group). Propensity score matching was applied to reduce the confounding effects. Factors affecting survival were assessed by Kaplan–Meier estimates and Cox regression analysis.

Results

The VATS procedure was associated with shorter operative time compared with the OT procedure (147.96 ± 58.91 min vs. 165.34 ± 58.91 min, P < 0.001). No significant difference was identified between the two groups in the number of dissected mediastinal lymph nodes (MLNs) and number of dissected MLNs stations. More patients after VATS procedure received postoperative adjuvant therapy (83.4% vs. 75.5%, P = 0.002). At a median follow-up of 36 (range 4–150) months, comparing VATS procedure and OT procedure, no significant differences were noted in 5-year DFS (20.7% vs. 22.5%, P = 0.89) and 5-year OS (30.7% vs. 34.5%, P = 0.821). The VATS procedure was not found to be an independent predictor of DFS (hazard ratio, 0.986; 95% CI, 0.809 to 1.202) or OS (hazard ratio, 0.977; 95% CI 0.802 to 1.191).

Conclusion

In this large propensity-matched comparison, the VATS procedure offered comparable short-term outcomes and long-term oncological efficacy for patients with pN2 NSCLC when compared with OT procedure.

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Funding

This study is supported by the Basic Science Program (2019YJ0077 to Chengwu Liu), Science & Technology Department of Sichuan Province, and the 1.3.5 Project for Disciplines of Excellence (ZYJC18009 to Jiandong Mei, and ZYGD18021 to Lunxu Liu), West China Hospital, Sichuan University.

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Author notes

  1. Chengwu Liu, Chenglin Guo, and Fanyi Gan contributed equally to this paper.

Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Chengwu Liu, Chenglin Guo, Fanyi Gan, Jiandong Mei, Qiang Pu, Zheng Liu, Yunke Zhu, Hu Liao, Lin Ma, Feng Lin & Lunxu Liu

  2. Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, 610041, China

    Chengwu Liu, Chenglin Guo, Fanyi Gan, Jiandong Mei, Qiang Pu, Zheng Liu, Yunke Zhu, Hu Liao, Lin Ma, Feng Lin & Lunxu Liu

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  1. Chengwu Liu
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Correspondence to Lunxu Liu.

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Drs. Chengwu Liu, Chenglin Guo, Fanyi Gan, Jiandong Mei, Qiang Pu, Zheng Liu, Yunke Zhu, Hu Liao, Lin Ma, Feng Lin, and Lunxu Liu have no conflicts of interest or financial ties to disclose.

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Liu, C., Guo, C., Gan, F. et al. Results of video-assisted thoracic surgery versus thoracotomy in surgical resection of pN2 non-small cell lung cancer in a Chinese high-volume Center. Surg Endosc 35, 2186–2197 (2021). https://doi.org/10.1007/s00464-020-07624-2

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