Which treatment procedure is safer and effective between VATS and Open Lobectomy?

This analysis compared survival rates, recurrence rates and complication rates in patients who underwent video-assisted thoracoscopic surgery and those who underwent open lobectomy.

Patients with early stage non-small cell lung cancer may undergo lobectomy (surgical removal of a lobe of the lung) to remove the cancer. Currently the main form is an open lobectomy whereby an incision is made on the front of the chest under the nipple line, extending around the back under the shoulder blade. The surgeon then enters the chest cavity through the exposed ribs to remove the cancerous lobe.

 However, in up to 32% of cases in the United States, surgeons are now using video-assisted thoracoscopic surgery. The surgeon makes very small incisions into the patient's body, and inserts an instrument called a thoracoscope, which is a thin, tube-like instrument with a small video camera at the end. This camera feeds video images to a screen and allows the surgeon to see and operate inside the chest and lungs in a minimally invasive manner. This analysis compared survival rates, recurrence rates (return of the cancer) and complication rates between patients with early-stage non-small cell lung cancer who underwent video-assisted thorascopic surgery and those who underwent open lobectomy.
 

The analysis involved 23 studies of patients with stage I non-small cell lung cancer. Out of 23 studies, nine had complete data on rate of survival. Seven of the nine studies showed that video-assisted thorascopic surgery had a better 5-year survival rate to open lobectomy. In those that didn’t, the difference between the groups was negligible. Statistical analysis determined that video-assisted thorascopic surgery was significantly favored over open lobectomy with regards to 5-year survival.

Out of 23 studies, five had complete data on rate of local recurrence. Only one of the studies reported a statistically significant result, showing a rate of 47% in video-assisted thorascopic surgery compared to 25% in open lobectomy. Out of 23 studies, only three had complete data on rate of distant recurrence, with no significant difference in rate of recurrence found.

Only six out of the 23 studies had complete data on total complication rate. Statistical analysis of these results showed that video-assisted thorascopic surgery was associated with a lower rate of complications than open lobectomy.

In summary,  video-assisted thorascopic surgery was associated with a greater 5-year survival rate but a higher local recurrence rate than open lobectomy in patients with stage I non-small cell lung cancer.

Most of the studies were retrospective (backward-looking) in nature.