Jinbo Zhao1, Weimiao Li2, Meng Wang3, Lunxu Liu4, Xiangning Fu5, Yin Li6, Lin Xu7,8, Yang Liu9, Heng Zhao10, Jian Hu11, Deruo Liu12, Jianfei Shen13, Haiying Yang14, Xiaofei Li1. 1. Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China. 2. Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 3. Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China. 4. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China. 5. Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 6. Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China. 7. Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute of Jiangsu Province, Nanjing, China. 8. Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing, China. 9. Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China. 10. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China. 11. Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, China. 12. Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China. 13. Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China. 14. Medical Affairs, Linkdoc Technology Co, Ltd, Beijing, China.
Abstract
BACKGROUND: The majority of previous studies of the clinical outcome of video-assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non-small cell lung cancer (pN2 NSCLC) have been single-center experiences with small patient numbers. The aim of this study was therefore to investigate these procedures but in a large cohort of Chinese patients with pathological N2 NSCLC in real-world conditions. METHODS: Patients who underwent lobectomy for pN2 NSCLC by either VATS or thoracotomy were retrospectively reviewed from 10 tertiary hospitals between January 2014 and September 2017. Perioperative outcomes and overall survival of the patients were analyzed. Cox regression analysis was performed to identify potential prognostic factors. Propensity-score analysis was performed to reduce cofounding biases and compare the clinical outcomes between both groups. RESULTS: Among 2144 pN2 NSCLC, 1244 patients were managed by VATS and 900 by open procedure. A total of 305 (24.5%) and 344 patients died during VATS and the thoracotomy group during a median follow-up of 16.7 and 15.6 months, respectively. VATS lobectomy patients had better overall survival when compared with those undergoing the open procedure (P < 0.0001). Multivariate COX regression analysis showed VATS lobectomy independently favored overall survival (HR = 0.75, 95% CI: 0.621-0.896, P = 0.0017). Better perioperative outcomes, including less blood loss, shorter drainage time and hospital stay, were also observed in patients undergoing VATS lobectomy (P < 0.05). After propensity-score matching, 169 patients in each group were analyzed, and no survival difference were found between the two groups. Less blood loss was observed in the VATS group, but there was a longer operation time. CONCLUSIONS: VATS lobectomy might be a feasible alternative to conventional open surgery for resectable pN2 NSCLC. KEY POINTS: Significant findings of the study: VATS lobectomy has comparative OS in pN2 NSCLC versus open procedure in resectable patients. WHAT THIS STUDY ADDS: VATS lobectomy might be feasible for pN2 NSCLC.
BACKGROUND: The majority of previous studies of the clinical outcome of video-assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non-small cell lung cancer (pN2NSCLC) have been single-center experiences with small patient numbers. The aim of this study was therefore to investigate these procedures but in a large cohort of Chinese patients with pathological N2NSCLC in real-world conditions. METHODS:Patients who underwent lobectomy for pN2NSCLC by either VATS or thoracotomy were retrospectively reviewed from 10 tertiary hospitals between January 2014 and September 2017. Perioperative outcomes and overall survival of the patients were analyzed. Cox regression analysis was performed to identify potential prognostic factors. Propensity-score analysis was performed to reduce cofounding biases and compare the clinical outcomes between both groups. RESULTS: Among 2144 pN2NSCLC, 1244 patients were managed by VATS and 900 by open procedure. A total of 305 (24.5%) and 344 patients died during VATS and the thoracotomy group during a median follow-up of 16.7 and 15.6 months, respectively. VATS lobectomy patients had better overall survival when compared with those undergoing the open procedure (P < 0.0001). Multivariate COX regression analysis showed VATS lobectomy independently favored overall survival (HR = 0.75, 95% CI: 0.621-0.896, P = 0.0017). Better perioperative outcomes, including less blood loss, shorter drainage time and hospital stay, were also observed in patients undergoing VATS lobectomy (P < 0.05). After propensity-score matching, 169 patients in each group were analyzed, and no survival difference were found between the two groups. Less blood loss was observed in the VATS group, but there was a longer operation time. CONCLUSIONS: VATS lobectomy might be a feasible alternative to conventional open surgery for resectable pN2NSCLC. KEY POINTS: Significant findings of the study: VATS lobectomy has comparative OS in pN2NSCLC versus open procedure in resectable patients. WHAT THIS STUDY ADDS: VATS lobectomy might be feasible for pN2NSCLC.
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