F-116 * video-assisted thoracic surgery versus open lobectomy for stage i non-small-cell lunger cancer: analysis of long-term outcomes and oncologic equivalency

Objectives: There is recent controversy in the literature regarding nodal upstaging and oncologic equivalency of video assisted (VATS) versus open lobectomy for non-small-cell lung cancer (NSCLC). This study seeks to compare nodal sampling and long-term outcomes in VATS versus open lobectomy in patients with stage I NSCLC. Methods: Seven hundred and twenty-four patients with pathologic stage I NSCLC treated with VATS or open lobectomy were retrospectively reviewed between 2006 and 2012. The total number of resected lymph nodes (RNs), and number of lymph node stations sampled (LNS) were recorded. Primary end-points were tumour recurrence, disease-free survival (DFS) and overall survival (OS). Multivariate analysis incorporated variables of interest to assess the effect of surgical approach on primary end-points. Results: VATS lobectomy was employed in 402 (55.5%) patients while 322 (44.5%) underwent open lobectomy. Baseline characteristics were similar between groups; however, mean tumour size was larger in the open group (2.5 ± 1.2 cm vs 2.3 ± 1.1 cm in VATS; P = 0.01). T2aN0 tumours were more commonly observed in the open group versus VATS (40.5% vs 29.6%, P = 0.003). On pathologic examination, median RNs and LNS was similar [9 (interquartile range: IQR 5-13.5) vs 9 (IQR 6-14), P = 0.67; and 4 (IQR 3-5) vs 4 (IQR 3-5), P = 0.90]. VATS lobectomy was associated with shorter hospital stay (P < 0.01) and reduced duration of chest drainage (P < 0.01). Five-year recurrence rate, DFS and OS in the open group was 21.5%, 73.4% and 62.0% vs 18.8%, 74% and 73% for VATS, respectively. On multivariate analysis time to recurrence was not different between the open and VATS approach (P = 0.63), but open lobectomy was associated with worse OS [HR: 1.62 (1.15-2.27), P = 0.005] and DFS [HR 1.43: (1.07-1.90), P = 0.015]. Median follow-up was 3.3 months for VATS and 3.9 months for open lobectomy. Conclusions: VATS lobectomy was associated with better OS and DFS compared with an open technique in pathologic stage I NSCLC. Time to recurrence was comparable between groups suggesting oncologic equivalency between open versus VATS lobectomy. Disclosure: No significant relationships.