Disease Free and Overall Survival is Equal in Open and VATS Resection for Early Lung Cancer in a Multivariate Analysis

Video-assisted thoracic surgery (VATS) has become a valid alternative to open resection for lung cancer treatment. However, robust data on the oncologic equality are still missing. This study evaluates disease free and overall survival for patients with early stage (cN0) lung cancer treated either with open or VATS resection. A total of 359 patients with early stage (cN0) lung cancer with available survival data in our institutional database were treated between 2004 and 2015. VATS was introduced in 2009, since that time all clinically nodal negative patients were treated with an intended VATS approach. There were 198 male patients; median age was 65 (range 38-85) years. 256 (71.3%) patients were treated with a minimally invasive approach. There were significantly more female patients (p=0.002) and lower pT-stages (p=0.002) in the VATS group. Nodal upstaging was found in 19.1% in the VATS group and 23.3% in the open group (p=0.486). 5-year disease free survival was 61.2% in the VATS group and 63.8% in the open group (p=0.492). 5-year overall survival was 84.3% in the VATS group and 73.3% in the open group (p=0.139), Figure 1. In a multivariate analysis including age, gender, pT-status, pN-status and surgical approach, none of the factors proofed to independently predict disease free survival. In overall survival, a positive pN status was found to be the only independent negative prognostic factor (HR: 2.2, 95% CI: 1.2-4.1). Overall and disease free survival are not influenced by the type of surgical approach. Due to perioperative benefits with shorter length of hospital stay and less complications, a minimally invasive approach as the gold standard of surgical treatment for clinically nodal negative lung cancer patients should be advocated.