The Role of Thoracoscopic Pneumonectomy in the Management of Non-Small Cell Lung Cancer: A Multicenter Study

OBJECTIVE: The objective of this study was to evaluate the impact of the video-assisted thoracoscopic (VATS) approach on the outcomes of patients who underwent pneumonectomy. METHODS: The effect of the surgical approach on perioperative complications and survival in patients who underwent pneumonectomy for non-metastatic non-small cell lung cancer (NSCLC) across 3 institutions (2000-2016) was assessed using multivariable logistic regression, Cox proportional hazard analysis and propensity-score matching. Completion pneumonectomies were excluded from this study and an “intent-to-treat” analysis was performed. RESULTS: During the study period, 359 patients met inclusion criteria and underwent pneumonectomy for non-metastatic NSCLC: 124 (35%) VATS and 235 (65%) thoracotomy. Perioperative mortality (VATS 7% [n=9] vs open 8% [n=19]; p=0.75) and morbidity (VATS 28% [n=35] vs open 28% [n=65], p=0.91) were similar between the groups, even after multivariable adjustment. Using a VATS approach, there was a significantly greater number of lymph nodes (p < 0.001) and N2 stations dissected (p < 0.001). Further, there was a significantly shorter chest tube duration for the VATS group (VATS 1.2±1.4 days vs open 1.5±1.4 days, p = 0.01). VATS showed similar 5-year survival when compared with thoracotomy in unadjusted analysis (47% [95% CI: 36-56] vs 33% [95% CI: 27-40]; p = 0.19), even after multivariable adjustment (HR = 0.76 [95% CI: 0.50-0.1.18]; p=0.23). In a propensity-score matched analysis that balanced patient characteristics, there were no significant differences found in overall survival between the two groups (p=0.69). CONCLUSION: Although the role of VATS pneumonectomy will likely become clearer as more surgeons report results, this multicenter study suggests that the VATS approach for pneumonectomy can be performed safely, with at least equivalent oncologic outcomes compared to thoracotomy.