Video-assisted thoracoscopic surgery (VATS) is associated with less postoperative pain and better quality of life than anterolateral thoracotomy for the first year of surgery in patients with stage I non-small cell lung cancer (NSCLC), a study published in the journal The Lancet Oncology has shown.1
Although the use of VATS as an alternative to thoracotomy for lobectomy has been increasing, this surgical approach remains controversial and worldwide adoption rates are low. Nonrandomized trials have demonstrated a reduction in postoperative morbidity with VATS, but high-quality evidence has not shown it to be superior to open surgery. Therefore, researchers sought to examine postoperative pain and quality of life of patients with early stage NSCLC undergoing VATS or open surgery.
For the study, researchers enrolled 206 patients with stage I NSCLC who were scheduled for lobectomy. Participants were randomly assigned 1:1 to undergo lobectomy via 4-port VATS or anterolateral thoracotomy. After surgery, identical surgical dressings were applied to all patients to ensure masking of patients and staff. Investigators measured postoperative pain 6 times per day during hospitalization and once at 2, 4, 8, 12, 26, and 52 weeks and assessed self-reported quality of life during hospital stay and at 2, 4, 8, 12, 26, and 52 weeks after discharge.
Results showed that 38% (95% CI, 28-48) of patients who underwent VATS had clinically relevant pain during the first 24 hours after lobectomy compared with 63% (95% CI, 52-72) of patients who had thoracotomy (P = .0012). Researchers found that episodes of moderate-to-severe pain were significantly less frequent during the 52 weeks of follow-up after VATS than after anterolateral thoracotomy (P < .0001).
In addition, self-reported quality of life was significantly better after VATS than after thoracotomy (P = .014) according to EuroQol 5 Dimensions (EQ5D); however, quality of life according to the European Organisation for Research and Treatment of Cancer (EORTC) 30 item Quality of Life Questionnaire (QLQ-C30) was not significantly different between the 2 treatment arms (P = .13).
In terms of postoperative surgical complications, grade 3 to 4 adverse events were similar between the 2 groups. Complications comprised of prolonged air leakage, re-operation for bleeding, twisted middle lobe, arrhythmia, and neurologic events
The findings ultimately suggest that VATS should be the preferred surgical strategy for lobectomy in stage I NSCLC.
1. Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial [published online ahead of print May 6, 2016]. Lancet Oncol. doi:10.1016/S1470-2045(16)00173-X.