Postoperative Complications and Outcome for all Stages with Non-Small Cell Lung Cancer after Video-Assisted Thoracoscopic Lobectomy and Open Lobectomy: A Propensity-Score Matched Analysis

Background: Postoperative complications and long-term outcomes after Video-Assisted Thoracoscopic (VATS) lobectomy and thoracotomy are still debated controversially in Non-Small Cell Lung Cancer (NSCLC).In this study we compared both surgical approaches in a retprospective propensity-score matched analysis. Methods:We reviewed data of all patients undergoing VATS or open lobectomy at the Lung Cancer Center Munich between 2011 and 2020.We excluded patients with conversion to thoracotomy.We used propensity score matching adjusted for difference in patient and tumor characteristics of VATS and thoracotomy patients.They were compared before and after matching using standardized differences.Surgical outcomes and complication rates were compared using paired t-test and McNmear test for paired samples.Survival was determined using Kaplan-Meier curves with LogRank test.Results: Of 1680 patients, we matched 434 with VATS to 434 patients with thoracotomy.Blood loss (>200ml) was significant less frequent after VATS.Other complication rates did not differ significantly between the two groups.Length of stay after resection was longer in thoracotomy (14.6 vs. 13.2,p=0.002), additionally the overall secretion via chest tube was higher (2330.6 ml vs. 1944.9ml, p=0.01).The length of chest tube duration did not differ significantly.The surgery in minutes was longer in VATS (185.5 vs. 173.3,p=0.002).Overall survival was better in patients with VATS (p=0.04). Conclusion:VATS and open lobectomy are still an indispensable part in the treatment of NSCLC in all operable tumor stages.Compared to the postoperative complications and survival both approaches can be performed as a safe and life-prolonging procedure.