Author of

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

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    P3.07-001 - Long-term outcome and current problems of VATS versus open lobectomy for clinical stage IA non-small cell lung cancer (ID 55)

    09:30 - 09:30  |  Author(s): A. Ohishi
    • Abstract

    Background
    The oncologic efficacy of lobectomy for lung cancer by means of video-assisted thoracic surgery (VATS) compared with conventional thoracotomy has been reported, and VATS lobectomy is now considered to be one of the standard surgical procedures for lung cancer. In this study, we retrospectively evaluated the long-term prognosis and some problems after VATS lobectomy, comparing with conventional thoracotomy, for clinical stage IA non-small cell lung cancer (NSCLC) in our institution.

    Methods
    From July 2002 to June 2012, 160 patients were diagnosed as clinical stage IA NSCLC and they underwent lobectomy. Of those 160 patients, 114 patients underwent VATS lobectomy and 46 patients underwent lobectomy under conventional thoracotomy. Patients’ clinical characteristics, recurrent status and overall survival were recorded. Disease free survival (DFS) and overall survival (OS) were calculated by means of Kaplan-Meier analysis and statistical significance between the groups was analyzed by using log-rank tests. Cox proportional hazard regression was used to ascertain independent predictors of recurrence.

    Results
    Median follow-up time was 44.8 months. 5-year DFS was 88.0% in VATS group and 77.1% in thoracotomy group in clinical stage IA (p=0.1504), and 91.5% in VATS group and 93.8% in thoracotomy group in pathological stage IA (p=0.2662). 5-year OS was 94.1% in VATS group, whereas 81.8% in thoracotomy group in clinical stage IA (p=0.0268), and 94.8% in VATS group and 96.2% in thoracotomy in pathological stage IA (p=0.5545). Cox proportional hazard analysis demonstrated a lower risk of recurrent disease in patients without lymph nodes metastases in this series (p=0.0026). The accurate diagnostic rate of preoperative staging was 71.9% in VATS group and 56.5% in thoracotomy group (p=0.2611). Inconsistent factors between clinical and pathological stage were largely tumor size (12.3% and 17.4%), nodal statement (10.0% and 21.1%) and pleural involvement (15.0% and 15.8%) in VATS group and thoracotomy group, respectively. There were 27 recurrent lesions (22 cases) at the first time of recurrence after surgery in this study. Twelve lesions (11 cases) with distant metastases were detected in VATS group, whereas 8 lesions (5 cases) were occurred distant metastases in thoracotomy group. Interestingly, only one lesion with local recurrence was detected in VATS group, whereas 6 lesions (5 cases) in thoracotomy group were detected (p=0.0495).

    Conclusion
    There was no significant inferiority for DFS and OS in VATS group, and local control was also significantly better in VATS group, compared with thoracotomy group. On the other hand, the significant difference of OS between two groups in clinical stage IA and multivariate analysis for recurrence showed the insufficiency of accurate staging before surgery.