gms | German Medical Science

Introduction: Open (via thoracotomy) lung lobectomy with systematic lymph node dissection is the gold standard treatment in early stage non-small cell lung cancer (NSCLC). However, video assisted thoracoscopic (VATS) lobectomy has been gaining increasing acceptance because of shorter hospital stay, less pain and earlier recovery. This study was performed to compare recurrence rates of patients after VATS- and open lobectomy for early stage lung cancer.

Material and methods: From 02/2009 until 09/2012, 209 patients were scheduled for minimally invasive lung lobectomy at our institution. Exclusion criteria were benign disease, clinical nodal invasion, tumor stage >T2b, conversion to thoracotomy and neoadjuvant therapy. Patients treated in the pre-VATS era between 2004 and 2007 with similar exclusion criteria served as a control group (thoracotomy group).

Results: 79 patients underwent VATS lobectomy for early stage NSCLC. The thoracotomy group consisted of 109 patients. Median follow-up was 25,5 (IQR 17,7 – 33,9) months in the VATS group and 40 months in the thoracotomy group. In the VATS group, tumor recurrence occurred in seven patients (8,8%; two cerebral metastases, two secondary primaries, three local recurrences) with a median disease free survival of 14 months. In the thoracotomy group, tumor recurrence occurred in 28 patients (25%) with a median disease free survival of 17 months. When compared in a Kaplan-Meier analysis, disease free survival was comparable in the VATS and thoracotomy group (p=0.1279, Figure 1 [Fig. 1]). Overall survival at 24 months was 100% in the VATS group an 92.7% in the thoracotomy group (p=n.s.).

Conclusion: In our series, recurrence rates and overall survival suggests the oncologic equality of a minimally invasive and open approach to lobectomy in NSCLC. VATS lobectomy should be offered to all early stage cancer patients.