title: Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy.
abstract: OBJECTIVE
  Lung cancer is the most common cause of cancer-related deaths worldwide. Survival is highly dependent on surgery. Video-assisted thoracoscopic surgery (VATS) is increasingly chosen over open thoracotomy (OT) because of the possible benefits of the minimally invasive approach. Consequently, our aim was to compare the 30-day morbidity and mortality for lung cancer patients operated by VATS lobectomy or lobectomy by OT.
  
  
  METHODS
  Data were obtained from prospective national and regional databases, including patients who underwent lobectomy for lung cancer in the eastern part of Denmark from 1 January 2005 to 31 December 2011. All patients operated before 2009 were re-staged according to the latest International Association for the Study of Lung Cancer lung cancer classification. Patient characteristics, comorbidities, pathology and operative data were assessed using an independent samples t-test, Pearson's χ(2), Fisher's exact test and Mann-Whitney test. Morbidity was assessed using multinomial logistic regression adjusted for gender, age, cancer stage, forced expiratory volume in 1 s (FEV1), year of surgery and Charlson comorbidity score.
  
  
  RESULTS
  In total, 1379 patients underwent lobectomy, 785 patients via VATS and 594 patients via thoracotomy. The two groups were similar in gender and FEV1. The patients operated by VATS were older (P < 0.001), and had a lower Charlson comorbidity score (P = 0.034), higher frequency of adenocarcinomas (P < 0.001) and lower cancer stage (P < 0.001). Among the VATS patients, 285 (36.3%) and among the thoracotomy patients, 288 (48.5%) had minor complications (P < 0.001); and 157 (20.0%) VATS patients and 212 (35.7%) thoracotomy patients had major complications (P < 0.001). The 30-day mortality rate was 1% in the VATS group and 1.5% in the thoracotomy group (P = 0.47). Multinomial logistic regression analysis showed that the prevalence of both minor [odds ratio (OR) = 1.51; 95% confidence interval (Cl) = 1.18-1.96] and major complications (OR = 1.91, 95% Cl = 1.44-2.53) was significantly higher for patients who underwent lobectomy via thoracotomy compared with VATS.
  
  
  CONCLUSIONS
  Patients undergoing lobectomy via VATS were less likely to have at least one minor complication within the first 30 postoperative days and less likely to have at least one major complication, compared with patients operated by thoracotomy. These findings remained after adjusting for gender, age, FEV1, cancer stage, year of surgery and Charlson comorbidity score.
authors.affiliation: Centre for Clinical Education, Centre for HR, The Capital Region of Denmark, Copenhagen, Denmark Department of Cardio-Thoracic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark tgf372@alumni.ku.dk.
authors.forename: Lykke Østergaard
authors.initials: LØ
authors.lastname: Laursen
authors.affiliation: Department of Cardio-Thoracic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: René Horsleben
authors.initials: RH
authors.lastname: Petersen
authors.affiliation: Department of Cardio-Thoracic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Henrik Jessen
authors.initials: HJ
authors.lastname: Hansen
authors.affiliation: Department of Environmental Medicine, University of Southern Denmark, Odense, Denmark.
authors.forename: Tina Kold
authors.initials: TK
authors.lastname: Jensen
authors.affiliation: Department of Cardio-Thoracic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Ravn
authors.affiliation: Centre for Clinical Education, Centre for HR, The Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000706:statistics & numerical data; D013908:Thoracotomy / Q000009:adverse effects* / Q000706:statistics & numerical data
keywords: Complications; Lung cancer; Morbidity; Thoracotomy; Video-assisted thoracoscopic surgery