Critical appraisal:Jeon JH, Kang CH, Kim HS, Seong YW, Park IK, Kim YT, et al 2013

Critical Appraisal

Article being appraised

Jeon JH, Kang CH, Kim HS, Seong YW, Park IK, Kim YT, et al. Video-assisted thoracoscopic lobectomy in non-small-cell lung cancer patients with chronic obstructive pulmonary disease is associated with lower pulmonary complications than open lobectomy: a propensity score-matched analysis. Eur J Cardiothorac Surg 2013 Sep 26 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24052605.

Applicable clinical question

Is minimally invasive lobectomy as effective as open lobectomy for treatment of operable stage I NSCLC?

Key Facts

Study Design

case-control study

Number of Patients:

91

Propensity matched study drawn from 283 STage I NSCLC pts undergoing VATS (n = 160) lobectomy and thoracotomy (n = 123) lobectomy
Single institution Korean population

Reported outcome(s):

operative mortality
Operation time (min)
Lymph nodes dissected
Overall complication (at least one)
Postoperative complications included overall complication rate, pulmonary complications, prolonged air leakage for more than 7 days, atrial fibrillation (AF), chylothorax, acute renal failure, reoperation, recurrent laryngeal nerve palsy and delirium.
Postoperative pulmonary complications included atelectasis and sputum retention requiring bronchoscopy, COPD aggravation, postoperative pneumonia, acute respiratory distress syndrome
and bronchopleural fistula.
length of hospital stay (days)

Results of outcome(s):

operative mortality was no different (VATS 1.2% vs THOR 2.3%, p=0.25)
operative time was significantly shorter for VATS (median VATS 165min vs THOR 195 min; p<0.04)
overall complications were no different except for ANY pulmonary complications (VATS 2.3% vs THOR 11%; p<0.01) and air leak>7 days (VATS 7.0% vs 22%; p<0.01)
length of hospital stay was significantly shorter for VATS 6 days (CI:3-22) than THOR 9 days (CI:3-349); p=0.04

Comments on results:

Morbidity and length of stay favours VATS

Includes an economic evaluation

no