title: Propensity Score Analysis Comparing Videothoracoscopic Lobectomy With Thoracotomy: A French Nationwide Study.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) lobectomy has recently become the recommended approach for stage I non-small cell lung cancer. However, these guidelines are not based on any large randomized control trial. Our study used propensity scores and a sensitivity analysis to compare VATS lobectomy with open thoracotomy.
  
  
  METHODS
  From 2005 to 2012, 24,811 patients (95.1%) were operated on by open thoracotomy and 1,278 (4.9%) by VATS. The end points were 30-day postoperative death, postoperative complications, hospital stay, overall survival, and disease-free survival. Two propensity scores analyses were performed: matching and inverse probability of treatment weighting, and one sensitivity analysis to unmask potential hidden bias. A subgroup analysis was performed to compare "high-risk" with "low-risk" patients. Results are reported by odds ratios or hazard ratios and their 95% confidence intervals.
  
  
  RESULTS
  Postoperative death was not significantly reduced by VATS whatever the analysis. Concerning postoperative complications, VATS significantly decreased the occurrence of atelectasis and pneumopathy with both analysis methods, but there were no differences in the occurrence of other postoperative complications. VATS did not provide a benefit for high-risk patients. The VATS approach decreased the hospital length of stay from 2.4 days (95% confidence interval, -1.7 to -3 days) to -4.68 days (95% confidence interval, -8.5 to 0.9 days). Overall survival and disease-free survival were not influenced by the surgical approach. The sensitivity analysis showed potential biases.
  
  
  CONCLUSIONS
  The results must be interpreted carefully because of the differences observed according to the propensity scores method used. A multicenter randomized controlled trial is necessary to limit the biases.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Centre Hospitalier Universitaire Dijon, Bocage Hospital, Dijon, France. Electronic address: pierrebenoit.pages@chu-dijon.fr.
authors.forename: Pierre-Benoit
authors.initials: PB
authors.lastname: Pagès
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Centre Hospitalier Universitaire Dijon, Bocage Hospital, Dijon, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Delpy
authors.affiliation: Department of Thoracic Surgery and Diseases of Oesophagus, Assistance Publique des Hôpitaux de Marseille, North Hospital, Marseille, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Orsini
authors.affiliation: Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.affiliation: Department of Thoracic Surgery, Centre Hospitalier Universitaire Rouen, Rouen, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Department of Thoracic Surgery and Diseases of Oesophagus, Assistance Publique des Hôpitaux de Marseille, North Hospital, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Department of Thoracic Surgery, Centre Hospitalier Universitaire Toulouse, Larrey Hospital, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Centre Hospitalier Universitaire Dijon, Bocage Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011013:Pneumonectomy / Q000379:methods*; D057216:Propensity Score; D012680:Sensitivity and Specificity; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome