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Douglas E. Wood
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J Thorac Cardiovasc Surg 2009;137:1415-1421
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Safety and efficacy of video-assisted versus conventional lung resection for lung cancer

Farhood Farjah, MD, MPHa, Douglas E. Wood, MDb, Michael S. Mulligan, MDb, Bahirathan Krishnadasan, MDb, Patrick J. Heagerty, PhDc, Rebecca Gaston Symons, MPHa, David R. Flum, MD, MPHa,d,*

a Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, Wash
b Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash
c Department of Biostatistics, University of Washington, Seattle, Wash
d Division of General Surgery, Department of Surgery, University of Washington, Seattle, Wash

Received for publication May 19, 2008; revisions received September 28, 2008; accepted for publication November 22, 2008.

* Address for reprints: David R. Flum, MD, MPH, Department of Surgery, University of Washington, 1959 NE Pacific, Box 356410, Seattle, WA 98195-6310. (Email: daveflum{at}u.washington.edu).

Objective: We sought to evaluate the use of video-assisted thoracoscopy among patients with lung cancer and its safety and effectiveness relative to conventional resection.

Methods: A cohort study (1994–2002) was conducted by using the Surveillance, Epidemiology, and End-Results Medicare database. Video-assisted thoracoscopy and conventional resection were hypothesized to be equivalent in terms of risks of death. Equivalency was defined by a confidence interval of 0.72 to 1.28 for the odds of 30-day death and 0.89 to 1.11 for the hazard of death, corresponding to a difference of no more than 1% for 30-day mortality and 5% for 5-year survival, respectively.

Results: Among 12,958 patients who underwent segmentectomy or lobectomy (mean age, 74 ± 5 years), 6% underwent video-assisted thoracoscopy. The use of video-assisted thoracoscopy increased from 1% to 9% between 1994 and 2002. Compared with those who underwent conventional resection, patients who underwent video-assisted thoracoscopy more frequently had smaller tumors (P < .001) and stage I disease (P = .03), underwent lymphadenectomy (P < .001), and were cared for by higher-volume surgeons (P < .001) and at higher-volume hospitals (P < .001). After adjusting for differences in patient, cancer, management, and provider characteristics, the odds of early death were not significantly different between patients undergoing video-assisted thoracoscopy and those undergoing conventional resection, although equivalency was not demonstrated (adjusted odds ratio, 0.93; 95% confidence interval, 0.57–1.50). The hazard of death was equivalent for video-assisted thoracoscopy and conventional resection (adjusted hazard ratio, 0.99; 95% confidence interval, 0.90–1.08).

Conclusions: Video-assisted thoracoscopy was uncommonly used to manage lung cancer, although its use has increased over time. Video-assisted thoracoscopy and conventional resection were equivalent in terms of long-term survival.

Abbreviations and Acronyms CI = confidence interval; HCPCS = Healthcare Common Procedure Coding System; LOS = length of stay; SEER = Surveillance, Epidemiology, and End-Results; VATS = video-assisted thoracoscopy




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