Long-term survival outcomes of Video-assisted Thoracic Surgery (VATS) lobectomy after transitioning from open lobectomy.

Background: Open lobectomy continues to be more commonly performed than video-assisted thoracic surgery (VATS) lobectomy. We previously described the short-term safety of an approach for transitioning from open lobectomy to VATS. We now assess its long-term safety by evaluating survival results of the initial VATS cases after transition.

Methods: From a prospective database, survival of stage I non-small cell lung cancer was compared between the first 40 VATS lobectomy and the 40 open lobectomy performed just before the transitioning to VATS. All patients underwent staging by positron emission tomographic scan and mediastinoscopy. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test.

Results: Patient and intraoperative characteristics were not different between the two groups, except for operative time, which was longer for VATS (median 132 vs. 150 min, p = 0.023) and tumor size, which was smaller for VATS (median 2 vs. 2.5 cm, p = 0.002). There was no difference in morbidity and mortality. Median follow-up was 118 months for the open group and 81 months for the VATS group. The 5-year disease-free survival for stage IA (90 % open vs. 97 % VATS, p = 0.439) and IB (74 % open vs. 79 % VATS, p = 0.478) were not different. The 5-year overall survival for stage IA (91 % open vs. 97 % VATS, p = 0.152) and IB (55 % open vs. 67 % VATS, p = 0.198) were also not different.

Conclusions: The transition from open to VATS lobectomy is safe with regards to both short-term morbidity and long-term survival. Surgeons currently performing open lobectomy should consider transitioning to the VATS procedure.