Long-term oncological outcome after thoracoscopic lobectomy for non-small cell lung cancer patients

Masayuki Nakao, Junji Ichinose, Yosuke Matsuura, Ken Nakagawa, Sakae Okumura, Mingyon Mun


Background: Thoracoscopic surgery (TS) has been used more commonly as a less invasive procedure for early-stage non-small cell lung cancer (NSCLC) than conventional thoracotomy (TH) in Japan. However, limited evidential data are available to compare the treatment efficacy of TS and TH. The purpose of this study was to retrospectively investigate the difference in the long-term outcome and invasiveness of TS and TH.
Methods: Total 1,166 NSCLC patients who underwent surgery between 2005 and 2013 were enrolled. Of these, 844 patients underwent surgery via TH and 322 via TS. We compared several clinicopathological factors and the long-term outcome between the two groups. We performed propensity score matching analysis to minimize differences in the patient background and tumor states.
Results: The TS group included more women, non-smokers or light smokers, and healthy patients. In the TS group, the disease states were significantly less aggressive. The TS group had a much better 5-year overall survival (OS) rate of 92.6% as compared to 76.7% in the TH group (P<0.0001). Using propensity score matching, we extracted 190 patients each from the two groups. No statistical differences were present in the OS rates of the two matched groups (P=0.2223), indicating the achievement of adequate balance. For a balanced cohort, intraoperative blood loss was significantly less, and the duration of postoperative drainage was shorter in the TS group.
Conclusions: We observed excellent long-term oncological outcomes in NSCLC patients after TS, with comparable treatment outcomes and less-invasiveness than TH.