Is minimally invasive lobectomy as effective as open lobectomy for treatment of operable stage I NSCLC?
Minimally invasive lobectomy is performed with the intention of achieving the same oncological outcomes as traditional lobectomy by thoracotomy, but with lesser impact in terms of pain, cosmesis, morbidity and post-operative recovery. The definition of minimally invasive lobectomy is somewhat broad, with variations in the size of the utility incision, use of rib-spreading, hilar dissection and node dissection. For the purpose of this guideline, minimally invasive (also known as Video-Assisted Thoracic Surgery, VATS or Thoracoscopic) lobectomy consists of a non-spreading utility incision, three to four instrument ports and dissection of individual hilar structures (viz. bronchus, artery, vein).
There has only been a single small pseudo-randomised controlled trial (randomised by ID number) showing equivalence in long term oncological outcomes with minimally invasive lobectomy. The remaining long term survival evidence comes from systematic reviews of VATS lobectomy based on case-matched and propensity scored series. Relative risks for death within five years are either equivalent, or in the range of 0.45-0.97 with median relative risk in the range of 0.66-0.72 in favour of minimally invasive lobectomy.
Evidence from a further small randomised controlled trial and the above systematic reviews and propensity-scored analyses demonstrate a benefit for minimally invasive lobectomy with respect to overall complications and pulmonary complications. There appears to be a reduced risk of atrial fibrillation with minimally invasive lobectomy, but this evidence is derived only from propensity-scored and retrospective cohort studies.
Evidence summary and recommendations
Long term survival after minimally invasive lobectomy for operable stage I NSCLC
| Minimally invasive lobectomy is at least as effective as open lobectomy with respect to long term survival.
Last reviewed December 2015
|III-1, III-2||, , , , |
| Minimally invasive lobectomy may be superior to open lobectomy with respect to reported post-operative complication rates.
Last reviewed December 2015
|II, III-2||, , , |
Minimally invasive lobectomy is at least as effective as open lobectomy with respect to long term survival and reported post-operative complication rates.
Last reviewed December 2015
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