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Complete thoracoscopic lobectomy versus hybrid video-assisted thoracoscopic lobectomy for non-small cell lung cancer

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Abstract

Objective

Video-assisted thoracoscopic surgery (VATS) is the standard approach to lobectomy for early-stage non-small cell lung cancer (NSCLC). However, there are many different types. One of its approaches is complete thoracoscopic surgery (CTS), which may be less invasive because of low chest wall stress. This study compared the treatment outcomes of CTS and hybrid VATS lobectomy for NSCLC.

Methods

In total, 442 eligible patients with clinical N0 NSCLC underwent lobectomy between 2007 and 2016. Patients were classified into a group of patients who underwent CTS and a group of those who underwent hybrid VATS. Propensity score matching was performed between the two groups.

Results

There were 175 patients after matching. The median follow-up period in the CTS and hybrid VATS groups was 60 and 63 months, respectively. The CTS group showed less blood loss (CTS, 50 mL vs. 100 mL, p = 0.005), fewer complications (CTS, 25.7% vs. 36.6%, p = 0.037), and shorter postoperative hospital stays (CTS, 8 days vs. 12 days, p < 0.001). There was no significant difference in the postoperative 30-day mortality rates. Between the patients who underwent CTS and hybrid VATS groups, the 5-year overall survival rates were 85.4% and 86.0% (p = 0.701), the relapse-free survival rates were 76.5% and 74.9% (p = 0.435), and the lung cancer-specific survival rates were 91.5% and 91.7% (p = 0.90), respectively.

Conclusions

CTS is less invasive and has superior short-term outcomes as an approach to lobectomy for early-stage NSCLC.

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Data availability

The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study.

Abbreviations

CCI:

Charlson comorbidity index

CI:

Confidence interval

CT:

Computed tomography

CSS:

Cancer-specific survival

CTS:

Complete thoracoscopic surgery

JATS:

Japanese association for thoracic surgery

NSCLC:

Non-small cell lung cancer

OS:

Overall survival

PS:

Performance status

RFS:

Relapse-free survival

VATS:

Video-assisted thoracoscopic surgery

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Acknowledgements

We acknowledge members of the thoracic surgery department at Shimane University Hospital for their assistance in this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Shimane University Hospital, 89-1, Enyacho, Izumoshi, Shimane, 693-8501, Japan

    Tomohiro Fujita, Akira Koyanagi & Koji Kishimoto

  2. Department of Thoracic Surgery, National Hospital Organization Hamada Medical Center, 777-12, Asaicho, Hamadashi, Shimane, 697-8511, Japan

    Tomohiro Fujita

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  1. Tomohiro Fujita
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Correspondence to Tomohiro Fujita.

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Tomohiro Fujita, Akira Koyanagi, and Koji Kishimoto have no conflict of interest.

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Fujita, T., Koyanagi, A. & Kishimoto, K. Complete thoracoscopic lobectomy versus hybrid video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg 72, 31–40 (2024). https://doi.org/10.1007/s11748-023-01947-2

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