Clinical outcome following video-assisted thoracoscopic surgery (VATS) or thoracotomy in the surgical management of lung cancer: A multicentre UK analysis from 2001-2013


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Jason Sangha1, Felicity Evison2, Daniel Ray2, Paul Moss2
1University of Birmingham, Birmingham, UK, 2University of Birmingham, University Hospitals Birmingham NHS Foundation Trust and Birmingham CRUK Centre, Birmingham, UK

Background

The role of video-assisted thoracoscopic surgery (VATS) in the routine management of early stage non-small cell lung cancer (NSCLC) remains controversial. Concerns about operative safety and the oncological adequacy of VATS compared to thoracotomy have limited the uptake of VATS as a surgical approach towards NSCLC. We have compared the demographic profiles and clinical outcome of patients with lung cancer treated with VATS or thoracotomy.

Method

We utilised data from the Hospital Episode Statistics (HES) database of inpatients in England. The ICD-10 classification was used to identify patients with a diagnosis of lung cancer and OPCS codes identified the surgical procedure used to treat the malignancy. Data were then extracted into SPSS for statistical analysis. For all reported analyses, p≤0.001.

Results

During 2001-2013 we identified 36,400 patients having undergone surgery for lung cancer. Of these, 32,470 (90%) underwent thoracotomy whereas 3617 (10%) were treated with VATS. Patients undergoing VATS were significantly older (68.6 vs. 66.6yrs), from a less deprived area, had a higher Charlson comorbidity index (4.94 vs. 4.56), shorter duration of hospital stay (7.94 vs. 10.9 days), and were less likely to be readmitted within 28 days (0.4% vs. 5.6%). Post-operative mortality at 30 days was lower with VATS (1.6% vs. 3.1%) and Kaplan-Meier survival analysis demonstrated improved survival with VATS, with a median survival of 6.12yrs compared to 4.80yrs with thoracotomy. Cox regression incorporating age and Charlson comorbidity index found VATS was associated with improved survival, with a hazard ratio of 0.726 (95% CI: 0.677-0.778).

Conclusion

To our knowledge, this is the largest study to have compared outcomes between VATS and thoracotomy. We conclude that VATS is a safe and effective procedure for the treatment of NSCLC. Comparative multicentre studies incorporating staging information are urgently required to further evaluate VATS.