Video-assisted thoracoscopic versus open thoracotomy lobectomy: a Swedish nationwide cohort study

Abstract

Background: The aim of this nationwide observational cohort study was to investigate the early postoperative complications and long-term survival following video-assisted thoracoscopic surgery (VATS) lobectomy compared to open thoracotomy lobectomy for early stage non-small cell lung cancer (NSCLC).

Methods: We used the Swedish national quality register for general thoracic surgery and included all patients who underwent lobectomy for NSCLC during 2012-2015. We compared postoperative complications and long-term survival in patients who underwent VATS lobectomy at our institution to patients who underwent open lobectomy at the other seven hospitals in Sweden. We used inverse probability of treatment weighting to limit differences in baseline characteristics between the groups and used standardized mean differences to assess balance after weighting.

Results: We included 1,601 patients who underwent open (n=1,316) or VATS (n=285) lobectomy for NSCLC. The mean age was 67.7 years in both groups and comorbidities were well balanced, but the open thoracotomy group had a higher proportion of patients with more advanced cancer stage. After weighting, all baseline characteristics were well balanced. Most patients (84%) did not have postoperative complications; 83% vs. 86% in the open and VATS group, respectively (P=0.41). The 30- and 90-day mortality was 0.7% vs. 0.3% (P=0.38) and 1.7% vs. 0.3% (P=0.09) in the open thoracotomy and VATS group, respectively. There were significantly more transfusions (5.0% vs. 1.4%, P=0.008) and pneumonia (5.5% vs. 0.6%, P=0.002) in the in the open thoracotomy and VATS group, respectively. The overall survival at 1 and 5 years was 92% vs. 97% and 63% vs. 78% in the open thoracotomy and VATS group, respectively; HR (95% CI): 0.47 (0.33-0.68).

Conclusions: We found less postoperative complications and better long-term survival following VATS lobectomy compared to open thoracotomy lobectomy for NSCLC. The implementation of a VATS lobectomy program did not compromise patient safety or the oncological efficacy.

Keywords: Video-assisted thoracoscopic surgery (VATS); lobectomy; non-small cell lung cancer (NSCLC).

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Study inclusion flowchart. VATS, video-assisted thoracoscopic surgery.

Figure 2

Number of operations per year. (A) The number of operations per year in the total study population. The number of VATS lobectomies increased during the study period, but the number of open thoracotomies remained stable; (B) the number of lobectomies performed per year at Karolinska University hospital and by the end of the study period, VATS lobectomy was more common than open thoracotomy. VATS, video-assisted thoracoscopic surgery.

Figure 3

Survival after open thoracotomy or minimally invasive lobectomy. Survival is plotted against time after surgery and stratified according to type of surgery, open thoracotomy (black line) or minimally invasive lobectomy (red line). The group of patients who underwent open thoracotomy lobectomy (black line) is the reference group. Note that the numbers of patients at risk shown below the graph are not necessarily integers owing to inverse probability of treatment weighting. HR, hazard ratio; CI, confidence interval; VATS, video-assisted thoracoscopic surgery.