VATS versus Open Lobectomy following Induction Therapy for Stage III NSCLC: A Propensity Score-Matched Analysis

SIMPLE SUMMARY: Although video-assisted thoracoscopy surgery is now considered the standard treatment for early-stage lung cancer, the relevance of VATS in locally advanced lung cancer remains unknown. Several studies have been conducted to assess the feasibility and safety of VATS lobectomy for locally advanced NSCLC. However, only a handful have used propensity score matching to compare the operative and oncologic outcomes of VATS versus open lobectomy. Furthermore, these studies included a mixture of stages (II, III, and IV) and did not particularly evaluate the significance of VATS in the treatment of stage III disease. In this study, we compared the perioperative and oncologic outcomes of VATS with open lobectomy for stage III NSCLC and used propensity score matching to produce a well-balanced cohort of patients undergoing VATS and open lobectomy in order to minimize selection bias and achieve convincing statistical results. ABSTRACT: Objectives: This study aims to evaluate the perioperative and oncologic outcomes of thoracoscopic lobectomy for advanced stage III NSCLC. Methods: We retrospectively reviewed 205 consecutive patients who underwent VATS or open lobectomy for clinical stage III lung cancer between January 2013 and December 2020. The perioperative and oncologic outcomes of the two approaches were compared. Long-term survival was assessed using the Kaplan–Meier estimator. Propensity score-matched (PSM) comparisons were used to obtain a well-balanced cohort of patients undergoing VATS and open lobectomy. Results: VATS lobectomy was performed in 77 (37.6%) patients and open lobectomy in 128 (62.4%) patients. Twelve patients (15.6%) converted from VATS to the open approach. PSM resulted in 64 cases in each group, which were well matched according to twelve potential prognostic factors, including tumor size, histology, and pTNM stage. Between the VATS and the open group, there were no significant differences in unmatched and matched analyses, respectively, of the overall postoperative complications (p = 0.138 vs. p = 0.109), chest tube duration (p = 0.311 vs. p = 0.106), or 30-day mortality (p = 1 vs. p = 1). However, VATS was associated with shorter hospital stays (p < 0.0001). The five-year overall survival (OS) and five-year Recurrence-free survival (RFS) were comparable between the VATS and the open groups. There was no significant difference in the recurrence pattern between the two groups in both the unmatched and matched analyses. Conclusion: For the advanced stage III NSCLC, VATS lobectomy achieved equivalent postoperative and oncologic outcomes when compared with open lobectomy without increasing the risk of procedure-related locoregional recurrence.