Survival Analysis of Early-Stage NSCLC Patients Following Lobectomy: Impact of Surgical Techniques and Other Variables on Long-Term Outcomes.

Abstract

Background: Surgical resection is a frontline management option for early-stage non-small cell lung cancer (NSCLC). Evolving techniques may be refining patient outcomes. This study compares the long-term survival of patients undergoing lobectomy for a primary NSCLC between video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). The secondary aim of this study is to identify the variables that influence immediate and long-term patient outcomes.

Method: This is a single-centre retrospective cohort analysis spanning 20 years. The study reports on the outcomes of 743 patients who underwent lobectomy for primary NSCLC. There are 598 VATS cases and 145 OT cases. Variables likely to influence long-term survival were assessed with Kaplan-Meier survival analysis. The effect of VATS on long-term survival was assessed using a propensity-adjusted analysis.

Results: Chronic obstructive pulmonary disease, history of other cancers, coronary artery disease, type 2 diabetes, and emphysema were the most common comorbidities reported in this cohort. The VATS technique showed shorter postoperative length of stay and fewer surgical complications compared with OT. There were no differences between VATS and OT in early mortality or completeness of the resection. Additionally, 32% of patients showed variable visceral pleural invasion (P1-P2), and their 5-year survival was significantly worse compared with P0 patients (18.75% and 36.85%, respectively). Major pulmonary complications were responsible for prolonging the length of hospital stay after index surgery and it was inversely related to the survival at 5 and 10 years (p<0.0004). Lymph node involvement was an important predictor for long-term survival (50% overall survival rate was 9.4 years, 4.5 years and 4.2 years for N0, N1, and N2, respectively). We observed longer median survival in the VATS group (10.04 years vs 8.99 years) and a lower risk of mortality after propensity analysis (odds ratio 0.86; 95% confidence interval 0.67-1.11), but neither observation was statistically significant.

Conclusions: Early surgical outcomes were significantly better in the VATS group, whereas long-term outcomes were not notably different between the groups. Regardless of the surgical techniques used, positive surgical margins, visceral pleural invasion, larger tumours, positive lymph nodes, age >70 years, and prolonged hospital stay were common variables responsible for the poor overall long-term survival.