title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, murakawa-tky@umin.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Murakawa
authors.forename: Junji
authors.initials: J
authors.lastname: Ichinose
authors.forename: Haruaki
authors.initials: H
authors.lastname: Hino
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kitano
authors.forename: Chihiro
authors.initials: C
authors.lastname: Konoeda
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery*; D015505:Chest Tubes; D003952:Diagnostic Imaging; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D011013:Pneumonectomy / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D013997:Time Factors; D047368:Tumor Burden