Anatomic thoracoscopic lung resection for non-small cell lung cancer in stage I is associated with less morbidity and shorter hospitalization than thoracotomy

Figures & data

Table I. Lung resection patient characteristics.

	All patients (N = 328)			Propensity-matched (N = 232)
	Thoracotomy (N = 212)	VATS (N = 116)	p-value*	Thoracotomy (N = 116)	p-value*
Age, years (median, range)	65 (37–80)	69 (47–83)	0.001	68 (47–80)	0.174
Sex, n (Men/Women)	126/86	58/58	0.105	67/49	0.292
Non-smokers, n (%)	35 (15.4)	16 (13.8)	0.633	15 (12.9)	1.000
Pack years (median, range)	40 (3–126)	40 (2–150)	0.561	40 (0–110)	0.483
CCI (mean ± SD)	0.87 ± 1.14	1.14 ± 1.09	0.007	1.09 ± 1.17	0.544
Histology, n (%)			0.363		0.358
Adenocarcinoma	107 (50.5)	65 (56.0)		69 (59.5)
Squamous	72 (34.0)	34 (29.3)		30 (25.9)
Bronchoalveolar	18 (8.5)	11 (9.5)		10 (8.6)
Large cell	6 (2.8)	5 (4.3)		2 (1.7)
Other non-small cell	9 (4.2)	1 (0.9)		5 (4.3)
Clinical Stage, n (%)			0.005		0.779
T1	111 (52.4)	80 (69.0)		77 (66.4)
T2	101 (47.6)	36 (31.0)		39 (33.6)
Mediastinoscopy, n (%)	5 (2.4)	4 (3.4)	0.725	4 (3.4)	1.000
PET-CT, n (%)	29 (13.7)	51 (44.0)	0.001	14 (12.1)	0.001
Pulmonary function (actual values, mean ± SD)
FVC, l (n)	3.33 ± 0.88 (190)	3.02 ± 0.91 (101)	0.002	3.15 ± 0.88 (103)	0.223
% of predicted (n)	86.5 ± 16.6 (188)	85.2 ± 17.7 (101)	0.360	83.8 ± 15.7 (104)	0.829
FEV1, l (n)	2.40 ± 0.72 (207)	2.11 ± 0.72 (114)	0.001	2.24 ± 0.70 (113)	0.148
% of predicted (n)	77.9 ± 19.6 (207)	75.4 ± 21.9 (116)	0.176	74.3 ± 19.5 (116)	0.933
DLco % (n)	80.8 ± 21.2 (166)	70.0 ± 18.1 (85)	0.001	78.6 ± 19.7 (89)	0.004
DLco/VA % (n)	87.9 ± 19.2 (164)	75.7 ± 19.3 (83)	0.001	86.9 ± 19.1 (86)	0.001

VATS, video-assisted thoracoscopy; CCI, Charlson comorbidity index; SD, Standard deviation; PET-CT, Positron emission and computer tomography; FVC, Forced vital capacity; FEV₁, Forced expiratory volume in one second.

*χ² for categorical variables and 2-sample rank sum test for continuous variables.

Figure 1A-C. Kaplan-Meier analysis: Thoracotomy versus video-assisted thoracoscopic surgery, (A) All patients, (B) Node-negative patients and (C) Node-positive patients.

Table II. Operative and perioperative outcomes.

	All patients (N = 328)			Propensity-matched (N = 232)
	Thoracotomy (N = 212)	VATS (N = 116)	p-value*	Thoracotomy (N = 116)	p-value*
Lymph node stations sampled, n**	4.6 ± 1.8	2.8 ± 1.7	0.001	4.5 ± 1.8	0.001
Postoperative stay, days**	10.7 ± 6.9	7.5 ± 6.7	0.001	10.8 ± 7.4	0.001
In-hospital mortality, n (%)	6 (2.8)	3 (2.6)	1.000	4 (3.4)	1.000
Procedure, n (%)			0.005		0.031
Lobectomy	186 (87.7)	97 (83.6)		98 (84.5)
Segmentectomy	10 (4.7)	17 (17.0)		9 (7.8)
Bi-lobectomy	16 (7.5)	2 (1.7)		9 (7.8)
Complications, n (%)	57 (26.9)	18 (15.5)	0.020	31 (26.7)	0.026
Positive lymph nodes, n (%)			0.021		0.144
N1	26 (12.3)	4 (3.4)		10 (8.6)
N2	23 (10.8)	8 (6.9)		12 (10.3)
Adjuvant chemotherapy, n (%)	26 (12.3)	5 (4.3)	0.025	11 (9.5)	0.103
Pathological stage, n (%)			0.011		0.216
IA	92 (43.4)	73 (62.9)		66 (56.9)
IB	65 (30.7)	30 (25.9)		25 (21.6)
IIA	9 (4.2)	3 (2.6)		5 (4.3)
IIB	17 (8.0)	2 (1.7)		5 (4.3)
IIIA	23 (10.8)	8 (6.9)		11 (9.5)
IIIB	5 (2.4)	0 (0.0)		4 (3.4)
IV	1 (0.5)	0 (0.0)		0 (0.0)

VATS, video-assisted thoracoscopy; SD, standard deviation.

*χ² for categorical variables and 2-sample rank sum test for continuous variables.

**Presented as mean ± SD.

Table III. Postoperative complications, n (%).

	All cases (N = 328)		Propensity-matched (N = 232)
	Thoracotomy (N = 212)	VATS (N = 116)	Thoracotomy (N = 116)
Pulmonary complications
Empyema (%)	3 (1.4)	2 (1.7)	0 (0.0)
Pneumonia (%)	8 (3.8)	5 (4.3)	4 (3.4)
Respiratory failure (%)	1 (0.5)	0 (0.0)	1 (0.9)
Interstitial pneumonia (%)	2 (0.9)	0 (0.0)	1 (0.9)
Prolonged air leak* (%)	18 (8.5)	5 (4.3)	12 (10.3)
Cardiovascular complications
Arrythmia (%)	6 (2.8)	1 (0.9)	3 (2.6)
Pulmonary embolus (%)	0 (0.0)	1 (0.9)	0 (0.0)
Cerebral infarction (%)	2 (0.9)	0 (0.0)	2 (1.7)
Acute heart failure (%)	1 (0.5)	1 (0.9)	0 (0.0)
Other complications
Postoperative bleeding (%)	5 (2.4)	0 (0.0)	3 (2.6)
Chylothorax (%)	1 (0.5)	1 (0.9)	0 (0.0)
Renal failure (%)	1 (0.5)	0 (0.0)	0 (0.0)
Sepsis (%)	4 (1.9)	1 (0.9)	2 (1.7)
Subcutaneous seroma (%)	2 (0.9)	0 (0.0)	1 (0.9)
Total	55	12	30

VATS, video-assisted thoracoscopy.

*Over seven days.

Table IV. Comparison between patient characteristics and results, divided into two-year patient groups.

	2004–2005(N = 56)	2006–2007(N = 86)	p-value*	2008–2009(N = 90)	p-value*	p-value**
Age, years (median, range)	67 (53–80)	68 (37–82)	0.329	67 (47–82)	0.589	0.477
CCI (mean ± SD)	1.02 ± 1.21	0.98 ± 1.06	0.986	1.17 ± 1.20	0.410	0.335
Clinical Stage, n (%)			0.224		0.493	0.645
T1	29 (51.8)	54 (62.8)		53 (58.9)
T2	27 (48.2)	32 (37.2)		37 (41.1)
PET-CT, n (%)	2 (3.6)	31 (36.0)	0.001	39 (43.3)	0.001	0.357
Pulmonary function (actual values, mean ± SD)
FEV1 l (n)	2.43 ± 0.78 (55)	2.30 ± 0.67 (82)	0.454	2.13 ± 0.73 (88)	0.026	0.080
% of predicted (n)	78.4 ± 21.7 (56)	80.6 ± 20.2 (84)	0.689	72.5 ± 19.8 (90)	0.078	0.012
DLco % (n)	78.4 ± 19.9 (43)	80.6 ± 22.1 (49)	0.707	71.2 ± 17.7 (78)	0.069	0.029
DLco/VA % (n)	84.1 ± 15.6 (41)	85.0 ± 18.8 (54)	0.886	77.3 ± 18.8 (72)	0.056	0.080
VATS (%)	0 (0.0)	43 (50.0)	–	64 (71.1)	–	0.001
Lymph node stations sampled, n	4.8 ± 1.7	3.5 ± 2.0	0.001	3.8 ± 2.0	0.002	0.305
Postoperative stay, days	10.6 ± 5.6	8.6 ± 5.6	0.005	8.4 ± 7.4	0.001	0.119
In-hospital mortality, n (%)	2 (3.6)	3 (3.5)	–	1 (1.1)	–	–
Procedure, n (%)			0.665		0.122	0.128
Lobectomy	51 (91.1)	74 (86.0)		73 (81.1)
Segmentectomy	3 (5.4)	7 (8.1)		15 (16.7)
Bi-lobectomy	2 (3.6)	5 (5.8)		2 (2.2)
Complications, n (%)	16 (28.6)	18 (20.9)	0.320	19 (21.1)	0.324	0.977
Positive lymph nodes, n (%)			0.546		0.436	0.517
N1	3 (5.4)	9 (10.5)		7 (7.8)
N2	7 (12.5)	9 (10.5)		6 (6.7)
Adjuvant chemotherapy, n (%)	8 (14.3)	13 (15.1)	0.892	7 (7.8)	0.238	0.127
Postoperative stage, n (%)			0.195		0.101	0.648
IA	23 (41.1)	47 (54.7)		49 (54.4)
IB	22 (39.3)	20 (23.3)		26 (28.9)
IIA	1 (1.8)	4 (4.7)		2 (2.2)
IIB	1 (1.8)	5 (5.8)		7 (7.8)
IIIA	7 (12.5)	9 (10.5)		6 (6.7)
IIIB	2 (3.6)	1 (1.2)		0 (0.0)
IV	0 (0.0)	0 (0.0)		0 (0.0)

VATS, video-assisted thoracoscopy; SD, standard deviation; CCI, Charlson comorbidity index; PET-CT, Positron emission and computer tomography; FEV₁, Forced expiratory volume in one second.

*Pairwise comparison between 2004–2005 patient group and patient group; χ² for categorical variables and 2-sample rank sum test for continuous variables.

**Pairwise comparison between 2006–2007 and 2008–2009 patient groups; χ² for categorical variables and 2-sample rank sum test for continuous variables.