Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer

Juan J. Mafé, Beatriz Planelles, Santos Asensio, Jorge Cerezal, María-del-Mar Inda, Javier Lacueva, Maria-Dolores Esteban, Luis Hernández, Concepción Martín, Benno Baschwitz, Ana M. Peiró


Background: Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use.
Methods: A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed.
Results: One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05).
Conclusions: The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.