Long-Term Outcomes of Open and Video-Assisted Thoracoscopic Lung Lobectomy for the Treatment of Early Stage Non-small Cell Lung Cancer are Similar: A Propensity-Matched Study

Generally, in retrospective studies, favourable short- and long-term outcomes for patients after lung lobectomy for early stage non-small cell lung cancer (NSCLC) using video-assisted thoracoscopic surgery (VATS) have been reported. However, the interpretation of lung lobectomy outcomes may be biased in retrospective settings. We retrospectively reviewed patients who underwent lung lobectomy for cT1-2N0M0 NSCLC from 2001 to 2010. The outcomes of patients who underwent VATS lobectomy were compared to those who underwent open lobectomy before and after performing propensity score matching. Preoperative covariates were entered when developing the propensity score-matching model. This study reviewed the outcomes of 101 VATS patients and 184 open lobectomy patients. Before propensity score matching, the VATS group had a higher mean age (p < 0.0001), smaller solid tumour size (p = 0.0042), similar whole tumour size (p = 0.2082), and larger tumour-disappearance ratio (p = 0.0007). The VATS group had a shorter mean operation time (p = 0.0002), less blood loss (p < 0.0001), shorter chest tube duration (p = 0.0002), and shorter hospital stay (p < 0.0001). As for long-term outcomes, the VATS group had higher disease-free, disease-specific, and overall survival rates (p values by log-rank test: 0.0049, 0.0154, and 0.032, respectively). After propensity score matching, all differences, except operation time, blood loss, chest tube duration, and hospital stay, were no longer significant. VATS lobectomy is less invasive than open lobectomy, but in terms of survival outcomes, VATS lobectomy was oncologically equivalent to open lobectomy. The oncological benefit of VATS reported by retrospective studies might be overestimated.