Surgical Outcomes of Video-Assisted versus Open Pneumonectomy for Lung Cancer: A Real-World Study

SIMPLE SUMMARY: Video-assisted thoracoscopic surgery (VATS) is now a well-established approach for anatomical lobectomy in the treatment of early-stage lung cancer. However, it is more difficult and risky to do VATS for pneumonectomy, with a more than 20% conversion rate. The safety, feasibility and potential benefits of VATS pneumonectomy remain to be investigated. Therefore, we performed a real-world study to evaluate the safety and feasibility of VATS pneumonectomy for lung cancer patients more comprehensively, with special attention paid to conversion cases and appropriate patient selection. This is a retrospective study with a largest cohort from a single center. The conclusions can deepen our understanding of the risks and benefits of VATS pneumonectomy. ABSTRACT: Background: The safety, feasibility and potential benefits of Video-assisted thoracoscopic surgery (VATS) pneumonectomy remain to be investigated. Methods: Patients receiving VATS or Open pneumonectomy during the study period were included to compare surgical outcomes. Propensity-score matched (PSM) analysis was performed to eliminate potential biases. Results: From 2013 to 2020, 583 consecutive patients receiving either VATS (105, 18%) or Open (478, 82%) pneumonectomy were included. Conversion from VATS to open was found in 20 patients (19.0%). The conversion patients had similar rates of major complications and perioperative mortality compared with the Open group. After PSM, 203 patients were included. No significant differences were observed in major complications and perioperative mortality between the two groups. For patients with stage pT2 tumors, the major complication rate in the VATS group was significantly lower than in the Open group (7.6% vs. 20.6%, p = 0.042). Compared with left pneumonectomy, the incidence of bronchopleural fistula (BPF) was significantly higher in right pneumonectomy for both VATS (0 vs. 16.7%, p = 0.005) and Open (0.7% vs. 6.5%, p = 0.002) approaches. Conclusions: Perioperative results of VATS pneumonectomy are non-inferior to those of the Open approach. Conversion to open surgery does not compromise perioperative outcomes. Patients with lower pT stage tumors who need pneumonectomy may benefit from VATS.