title: Video-Assisted Thoracoscopic Surgery Is a Safe and Effective Alternative to Thoracotomy for Anatomical Segmentectomy in Patients With Clinical Stage I Non-Small Cell Lung Cancer.
abstract: BACKGROUND
  There is rising interest among thoracic surgeons in anatomical segmental resection for early-stage non-small cell lung cancer (NSCLC). In the current study we compared video-assisted thoracoscopic surgery (VATS) and thoracotomy approaches for segmentectomy to explore the safety and oncologic efficacy of VATS for stage I NSCLC.
  
  
  METHODS
  We retrospectively analyzed all patients who underwent segmentectomy for clinical stage I NSCLC from 2000 to 2013. Perioperative and oncologic outcomes were evaluated. The probabilities of disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and multivariate Cox regression analysis.
  
  
  RESULTS
  We identified 193 segmentectomies, including 91 (47%) performed by VATS and 102 (53%) performed by thoracotomy. Patients who underwent VATS, although older (median age 72 versus 68 years; p = 0.016), had similar sex distribution (63% versus 61% women; p = 0.792) and similar clinical stages as the thoracotomy group (stage IA: VATS, 93.4% versus thoracotomy 87.3%; p = 0.152). No significant differences were found in the final pathologic stages (p = 0.439), total number of lymph nodes (LNs) sampled (7 versus 8; p = 0.104), or median number of mediastinal LN stations sampled (2 versus 2; p = 0.234). VATS was associated with decreased length of stay (4 versus 5 days; p = 0.001) and decreased pulmonary complications (13.2% versus 26.5%; p = 0.022). Five-year DFS and OS favored VATS over thoracotomy (58% versus 47%; p = 0.013 and 75% versus 62%; p = 0.017, respectively). By multivariable analysis, the only predictor of poor DFS or OS was larger tumor size.
  
  
  CONCLUSIONS
  VATS segmentectomy is a safe and oncologically effective technique for the treatment of stage I NSCLC. Patients who underwent VATS had a shorter length of stay, fewer pulmonary complications, equivalent lymphadenectomy results, and similar oncologic outcomes compared with patients undergoing thoracotomy.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Galal
authors.initials: G
authors.lastname: Ghaly
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kamel
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York. Electronic address: nkaltork@med.cornell.edu.
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013908:Thoracotomy; D016896:Treatment Outcome