Long-Term Survival Analysis of Video-Assisted Thoracoscopic Surgery Lobectomy Patients

Context. There is very little published data for patients who are status-post lobectomy by Video-Assisted Thoracoscopic Surgery (V ATS) for lung cancer, which includes a 5 year survival analysis with a corresponding 5 year follow-up time period. To the author\u27s knowledge, there are no studies published to date that report a survival analysis for a time period greater than five years. Objective. To investigate both short and long term survival rates for patients having undergone VATS lobectomy for clinical stage I lung cancer, as well as identify any independent prognostic factors for survival. Design. Retrospective chart review; Period from 1992 to 2002; follow-up 18-143 months. Setting. Patients were referred from the general community to this private, general surgery group practice, with operations performed by Robert Schauer :MD, at a regional acute care hospital. Patients. One-hundred consecutive patients diagnosed with clinical stage I lung cancer and deemed eligible candidates for VATS lobectomy. Intervention(s). Non-rib spreading VATS lobectomy, bilobectomy, or pneumonectomy. Main Outcome Measure(s). Survival was calculated both directly and with the KaplanMeier method. Log-rank and Cox-proportional hazards regression were used for data analysis. Results. Kaplan-Meier analysis demonstrated five and seven year survival rates of 51.5% (Cl 0.735 to 0.296) and 38.2% (Cl 0.683 to 0.081) respectively with a mean follow-up of 63.52 months for all standard non-small cell cancer patients (n=89). There was no significant difference between VATS and open lobectomy survival curves (p=0.0946). Cancer stage was an independent prognosticator (p=0.032) of survival. Conclusion. VATS lobectomy is a comparatively safe surgical procedure with improved perioperative outcomes and survival rates at least equivalent to lobectomies by thoracotomy