The use of a video-assisted thoracoscopic surgery (VATS) in anatomical segmentectomy is safe and associated with improved outcomes in the treatment of non-small-cell lung cancer (NSCLS), according to a study presented here on January 27 at the 51st Annual Meeting of the Society of Thoracic Surgeons (STS).
In comparison to the conventional open approach to anatomical segmentectomy, the use of video-assistance can involve adjustments and pose some technical challenges.
In an effort to compare the two approaches, Galal Ghaly, MD, Cardiothoracic Surgery Department, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, and colleagues compared outcomes among 193 anatomical segmentectomies performed for NSCLC between 2000 and 2014, including 91 that involved VATS (47%) and 102 involving the conventional open approach (53%).
Patients treated with the VATS approach were older (72 vs 68 years; P = .016) but otherwise had had similar characteristics in comorbidity index and tumour classification compared with the thoracotomy patients.
In addition, both groups were similar in terms of the median number of lymph nodes and mediastinal lymph node stations sampled.
Results showed that, compared with thoracotomy, the VATS approach was significantly associated with a decreased length of hospital stay (4 vs 5 days; P = .001) and a reduction in pulmonary complications (8% vs 20%; P = .033).
There were no significant differences in the final pathologic stages between the group, although larger median tumour sizes were observed in the thoracotomy group (1.7 cm vs 1.5 cm; P = .034).
The 3-year overall survival for patients with stage IA NSCLC was similar between groups; however, the trend favoured the VATS group (90% vs 75%; P = .212).
VATS showed improved 3-year overall survival for the entire cohort, compared with thoracotomy (90% vs 71%; P = .018).
Overall, there were 9 (10%) complications in the VATS group, compared with 23 (23%) in the thoracotomy group (P = .03).
According to the authors, VATS anatomic segmentectomy is a feasible and oncologically safe technique, particularly for the treatment of stage IA NSCLC patients.
“VATS patients have shorter hospital stays and fewer pulmonary complications compared with those undergoing thoracotomy, [while receiving] equivalent lymphadenectomy to thoracotomy patients,” the authors wrote. “VATS patients had improved overall survival, although this may have been due to differences in patient selection.”
<h3>References</h3>
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