Stage II NSCLC: thorascopic lobectomy similarly effective to open surgery

  • Yang CJ & al.
  • Ann Surg
  • 26 Mar 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Patients with stage II NSCLC who underwent lobectomy via video-assisted thoracoscopic surgery (VATS) had similar rates of 30-day mortality, 30-day readmission, and upstaging with a lower length of stay (LOS) during the index hospitalization vs those undergoing open lobectomy.

Why this matters

  • VATS was underused in this study and should be considered more often for stage II NSCLC.

Study design

  • 1559 patients with clinical T1-2, N1, M0 NSCLC from the National Cancer Database who underwent lobectomy via VATS (n=355) or open surgery (n=1204) between 2010 and 2012.
  • Funding: None disclosed.

Key results

  • Overall, use of VATS increased 36% during the study period, increasing each year (19.4% in 2010, 22.9% in 2011, and 26.3% in 2012).
  • No significant difference between groups in rates of 30-day mortality, 30-day readmission, or nodal upstaging, but VATS group had significantly shorter LOS (5 vs 6 days; P<.001>
  • VATS was not associated with worse 5-year OS on multivariate analysis (aHR, 1.08; P=.39).
  • There was a higher rate of nodal downstaging from cN1 to pN0 with VATS compared with open lobectomy (27.8% vs 21.3%; P=.009).
  • Findings from propensity analysis mirrored those in the overall cohort.

Limitations

  • Retrospective study.

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