title: Is video-assisted lobectomy for non-small-cell lung cancer oncologically equivalent to open lobectomy?
abstract: OBJECTIVE
  The purpose of this study was to compare overall and disease-free survival after VATS and open lobectomy for clinical Stage I and II non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  A retrospective review of a prospective database of all patients undergoing VATS or open lobectomy for clinical Stage I or II NSCLC between 2002 and 2010 was performed. Postoperative outcomes, disease-free survival and overall survival were compared between the two groups after optimum 1:1 propensity matching for age, gender, tumour histology and pathological stage.
  
  
  RESULTS
  Over an 8-year period, 608 patients underwent lobectomy for NCSLC by VATS (n = 196, 32%) or open technique (n = 412, 68%). After matching, there were 190 patients in each group. Adenocarcinoma was found in 80% (open: 149, VATS: 152) and 55% of tumours were T1 (open: 108, VATS: 105). Pathological N1 disease was found in 21 and 19 patients in the open and VATS group, respectively. Disease-free 5-year survival was 69.1% for the open group vs 69.7% for VATS (P = 0.94). Cancer-specific 5-year survival was 82.9% for the open group vs 76.7% for VATS (P = 0.170). Five-year overall survival was 73% in the open group vs 64% in the VATS group (P = 0.17). Operative mortality and postoperative complications were not significantly different between groups.
  
  
  CONCLUSIONS
  Overall survival and disease-free survival are not significantly different when compared between VATS lobectomy and open lobectomy. VATS resection appears to provide an adequate oncological operation for patients with operable clinical Stage I and II NSCLC.
authors.affiliation: Department of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Waël C
authors.initials: WC
authors.lastname: Hanna
authors.forename: Moira
authors.initials: M
authors.lastname: de Valence
authors.forename: Eshetu G
authors.initials: EG
authors.lastname: Atenafu
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasufuku
authors.forename: Andrew
authors.initials: A
authors.lastname: Pierre
authors.forename: Marc
authors.initials: M
authors.lastname: De Perrot
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Gail E
authors.initials: GE
authors.lastname: Darling
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000401:mortality*
keywords: Lobectomy; Nodal staging; Non-small-cell lung cancer; Propensity matching; Video-assisted thoracic surgery