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High Local Recurrence After Video-Assisted Thorascopic(VATS) Lobectomy Compared With Open Lobectomy for Early Non-Small Cell Lung Cancer

Glenfield Hospital, Leicester, UK

PURPOSE: To compare the outcome of video assisted thorascopic (VATS) lung resection for non small cell lung cancer (NSCLC) with open surgery.

METHODS: A retrospective case note review comparing patients who underwent VATS lung resection between April 1997 and February 2003 using standard techniques without rib spreading with patients who underwent lobectomy between April 1997 and December 1999. All operations were for early stage NSCLC (T1/2, N0/1). All operations were part of a single thoracic surgical practice. The preoperative respiratory function, histology, stage, intercostal drain time, hospital stay and follow up data were analysed.

RESULTS: Video-assisted thoracoscopic resection was performed in 25 patients [11 male, median age 72 years (range 55–82)].They underwent 10 upper, 5 middle and 10 lower lobectomies. 102 patients underwent open lobectomy [66 male, median age 69 years (range 48–82)]. They underwent 67 upper, 1 middle and 34 lower lobectomies.

21 of 25 VATS patients had N0 disease compared with 75 of 102 open resection patients. Kaplan-Meier analysis was performed for survival, disease free survival and local recurrence.

CONCLUSION: VATS lobectomy has been used to extend resection to patients previously thought inoperable. The high local recurrence rate may be due to technical deficiencies of the operation or demonstrate a learning experience in our series. In our study there was a high rate of local recurrence there was no difference in overall survival.

CLINICAL IMPLICATIONS: The high local recurrence rate after VATS resection for early stage NSCLC compared with open surgery calls into question its validity as an oncological operation

Comparison of open and VATS lobectomies for early NSCLC Open n=102 VATS n=25 Significance FEV1 Median (range) 1.6L (0.68–3.6) 1.8L (0.35–2.59) NS Intercostal Drainage Medain (range) 5 days (1–55) 3 days (1–30) NS Hospital stay Median (range) 7 days (2–41) 6 days (3–31) p=0.04 Hospital mortailty 4 (3.9%) 1 (4%) NS Follow up Median (range) 53 months (37–71) 39 months (1–70) Three year survival 65% 75% NS Three year disease Free survival 57% 50% NS Local recurrence 13 (12.7%) 6 (24%) Three year free of Local recurrence 86% 61% p=0.05

DISCLOSURE: J. Pilling, None.