Short-term And Long-term Survival In Sleeve Lobectomy By VATS Versus Thoracotomy Basing On The Prospensity Score Matching

Objective:This study aims to evaluate the safety and efficacy of patients with centrally located lung cancer that depends on short-term and long-term survival in sleeve lobectomy by VATS versus thoracotomy basing on the prospensity score matching(PSM).Methods:A retrospective analysis was performed on consecutive patients with centrally located lung cancer who underwent sleeve lobectomy admitted in the Affiliated Hospital of Qingdao University from January 2010 through October 2014 by PSM analyses.A total of 21 of 42 patients were included in the study.T-test,χ2 test or Fisher’s exact test was used to compare the surgical indexes of the two groups.Logistic regression was used to compare tumor recurrence,Kaplan-Meier curve and Log rank test to compare survival.Results:116 patients with centrally located lung cance who underwent sleeve lobectomy.video-assisted thoracoscopic surgery sleeve lobectom(VSL)was performed in 33(28%)patients and open sleeve lobectomy(OSL)in 83(72%).After propensity-matched,each group has 21 patients.Before matched the diameter of tumours(3.21vs4.26,P=0.014),pTNM-stage(P=0.020),FEV1% predicted(89.45vs96.40,P=0.033)and DLCO% predicted(81.09vs107.89,P=0.000)have significant differences.These differences resolved after propensity matching.Both groups received R0 resection.One patient in the endoscopic group had enlarged sleeve lobar resection(double lobar resection);6 patients in the open group had enlarged sleeve lobar resection,including 4 cases of adjacent lobe partial resection,1 case of double lobar resection,and 1 case of superior vena cava Forming.Compared with the open group,the laparoscopic group had a longer operation time((296.9±73.6)min ratio(218.1±59.2)min,t=3.82,P=0.000),postoperative chest drainage time [(3.3±1.5)d(2.0±3.0)d,t=-0.93,P=0.014] and hospital stay [(6.7±2.8)d vs.(12.1±8.7),t=-1.72,P =0.009] were shorter.There was no significant difference in the number of lymph node dissection stations,number of nodes and positive lymph nodes between the N1 and N2 groups in both groups.The patients were followed up for 6 to 93 months with an average of 48.7 months.In matched analysis,the VATS group has a longer operative time(296.9vs218.1,P=0.000),but shorter postoperative drainage time(3.3vs5.2,P=0.014)and hospitalization time(6.7vs12.1,P=0.009)than that of the thoracotomy group.In matched analysis,Thirty-day in-hospital mortality was 0.0% and 1.2%,for VSL and OSL groups,respectively(P=NS).The patient died in the open group and died of massive hemoptysis on the 12 th postoperative day.In unmatched and matched analyses,no significant differences in overall morbidity,distant recurrence,1 year DFS,3 year DFS(76% vs 67%;P=0.957),1 year OS and 3 year OS(80% vs 85%;P=0.714)were found in the VSL and OSL groups,respectively.In unmatched analysis,local recurrence(P=0.014,OR=3.447,95%CI: [1.287,9.233])favoured VSL;however,after propensity matching there was no difference between of two groups in local recurence(P=0.496,OR=1.600,95%CI: [0.413,6.193]).Conclusion:Patients with centrally located lung cancer in overall morbidity,overall and disease-free survival aspects were no significant differences between VSL and OSL groups.For suitable patients,VSL is an acceptable safe and effective surgical procedure for patients with central lung cancer.