Propensity score-matching analysis of hybrid video-assisted thoracoscopic surgery and thoracoscopic lobectomy for clinical stage I lung cancer†.
OBJECTIVE
Video-assisted thoracoscopic surgery (VATS) lobectomy is classified into hybrid VATS (direct and video vision) and thoracoscopic VATS (video vision only). In this study, the outcomes of hybrid VATS and thoracoscopic VATS for clinical stage I lung cancer were compared using a propensity score-matching analysis.


METHODS
Hybrid and thoracoscopic VATS were performed in 178 and 76 patients, respectively. Propensity scores were calculated using logistic regression analysis and matched within a score of ±0.03 for age, sex, size of tumour, Charlson comorbidity index, preoperative therapy, percent vital capacity, forced expiratory volume in 1 s, clinical stage, pathological stage and histology.


RESULTS
In the non-matched analysis, the results for hybrid and thoracoscopic VATS, respectively, were as follows: mean age, 69 ± 9 and 66 ± 10 years (P = 0.04); tumour size, 24 ± 10 and 20 ± 7 mm (P < 0.01); 2-deoxy-2 [F-18]fluorodeoxyglucose positron emission tomography SUV, 5.6 ± 4.4 and 3.6 ± 3.2 (P < 0.01); clinical stage (IA/IB), 130/48 and 69/7 (P < 0.01); pathological stage (IA/IB/IIA and IIB/IIIA and IIIB), 89/56/15/18 and 57/14/2/3 (P < 0.01); postoperative complications, 66 (37.1%) and 16 (21.1%; P = 0.01); respiratory complications, 32 (18.0%) and 6 (7.9%; P = 0.04); 5-year overall survival (OS), 77.0 and 88.8% (log-rank P = 0.045); and 5-year disease-free survival (DFS), 67.2 and 81.1% (log-rank P = 0.02). In 66 matched cases, the results for hybrid and thoracoscopic VATS, respectively, were as follows: mean operative time, 245 ± 96 and 285 ± 85 min (P = 0.01); blood loss, 95 ± 100 and 86 ± 123 ml (P = 0.67); mean duration of drainage, 3.6 ± 2.7 and 3.2 ± 2.2 days (P = 0.37); postoperative complications, 21 (31.8%) and 14 (21.2%; P = 0.17); respiratory complications, 11 (16.7%) and 5 (7.6%; P = 0.11); 5-year OS, 72.5 and 86.0% (log-rank P = 0.25); and 5-year DFS, 68.4 and 77.2% (log-rank P = 0.17).


CONCLUSIONS
In this single-institution, propensity score-matched study, hybrid VATS showed a shorter operative time and similar outcomes compared with thoracoscopic lobectomy for clinical stage IA lung cancer.
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan ihisashi@gifu-u.ac.jp.
Hisashi
H
Iwata
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Koyo
K
Shirahashi
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Hirotaka
H
Yamamoto
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Tsutomu
T
Marui
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Shinsuke
S
Matsumoto
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Yoshimasa
Y
Mizuno
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Mitsuyoshi
M
Matsumoto
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Shohei
S
Mitta
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Yusaku
Y
Miyamoto
Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan.
Hiroyasu
H
Komuro
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D057216:Propensity Score; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*
Hybrid video-assisted thoracoscopic surgery lobectomy; Non-small-cell lung cancer; Thoracoscopic lobectomy