Pleural recurrence and long-term survival after thoracotomy and thoracoscopic lobectomy

There are concerns over procedure-related pleural dissemination during video-assisted thoracic surgery (VATS) lobectomy. We compared the incidence of pleural recurrence and long-term survival between patients undergoing thoracotomy and VATS lobectomy for non-small cell lung cancer (NSCLC) with visceral pleural invasion.

From 2004 to 2009, 2,774 patients underwent curative-intent pulmonary resection for NSCLC at our institution. Of those, 478 patients were pathologically confirmed to have visceral pleural invasion by primary tumor. Among these, 239 patients (50%) underwent VATS lobectomy and 239 (50%) underwent thoracotomy lobectomy. Their medical records were retrospectively reviewed and a propensity score-matched analysis was performed.

Matching based on propensity scores produced 167 patients in each group. There were no significant differences between two groups in age, sex, histologic type, tumor size, and pathologic N stage. The median follow-up duration was 52 months. During follow-up, 14 patients (8.4%) from the VATS group and 12 (7.2%) from the thoracotomy group had ipsilateral pleural recurrence (p = 0.735). There was no significant difference in the recurrence pattern between the two groups. Overall survival at 5 years was 83% and 74% in the VATS and thoracotomy groups, respectively (p = 0.16). Disease-free survival at 5 years was 65% and 62% in the VATS and thoracotomy groups, respectively (p = 0.45).

Compared with thoracotomy, VATS lobectomy does not seem to increase the risk of procedure-related pleural dissemination in patients with NSCLC with visceral pleural invasion. Long-term survival and pattern of recurrence were similar between the two groups.