VATS Lobectomy For Early NSCLC May Reduce Pain, Improve QoL Versus Open Surgery

A video-assisted thoracoscopic surgical approach may offer pain and quality of life benefits for non-small-cell lung cancer patients who require lobectomy

medwireNews: Postoperative pain and quality of life (QoL) may be better after video-assisted thoracoscopic surgery (VATS) than with an anterolateral thoracotomy approach, suggests a study of patients undergoing lobectomy for stage I non-small-cell lung cancer (NSCLC).

The 102 patients who underwent four-PORT VATS were significantly less likely to experience clinically relevant pain, defined as a score of 3 or above on a numerical rating scale where 0 equals no pain and 10 the worst pain, in the first 24 hours after lobectomy than the 99 patients who underwent open surgery, at 38% versus 63%.

And VATS continued to be associated with fewer episodes of moderate to severe pain than thoracotomy at regular assessments over 52 weeks of follow-up, although there was no difference in the occurrence of severe pain (>7) between the groups, the investigators report in The Lancet Oncology.

Self-reported overall QoL, according to EuroQol 5 Dimension (EQ5D) scores, was also significantly higher throughout follow-up for the VATS patient group, although there were no significant differences for the individual dimensions at most of the time points.

Data from the European Organisation for Research and Treatment of Cancer 30-item questionnaire indicated the VATS and thoracotomy patient groups had comparable overall QoL, although the VATS patients had significantly better emotional function throughout follow-up.

Peter Licht, from Odense University Hospital in Denmark, and co-authors write that the VATS and thoracotomy patient groups had a comparable number of grade 3–4 postoperative complications (24 vs 25) and deaths in the year following surgery (3 vs 6).

VATS took significantly longer than thoracotomy (median 100 vs 79 min) but was associated with lower perioperative blood loss (median 50 vs 100 mL) and a shorter hospital stay (median 4 vs 5 days).

“Although our findings suggest that VATS is more beneficial than anterolateral thoracotomy in the surgical treatment of early stage non-small-cell lung cancer, we believe that further trials should be done to compare VATS with thoracotomy in more patients and preferably in a multicentre setting that includes both high-volume and low-volume centres, since it might not be possible to extrapolate our findings to centres with less experience of VATS procedures”, the researchers caution.

“Other relevant questions to investigate include the role of VATS for patients on chronic pain medication, comparison of VATS with posterolateral thoracotomy, specific investigation of whether VATS is more beneficial when done with fewer portholes, and eventual investigation of the effect of VATS on survival as a study endpoint”, they note.

Writing in a linked comment, Francesco Petrella and Lorenzo Spaggiari, from the University of Milan in Italy, agree that VATS lung resection for early-stage lung cancer appears to be “feasible and safe” with “very good” outcomes for postoperative pain and QoL, but emphasize the need for long-term oncological outcome data.

“Our personal experience of comparing standard lateral thoracotomy, VATS, and robotic-assisted thoracic surgery has suggested no differences in medium-term oncological results”, they write, but add that “a longer follow-up period will be needed before consolidating results are available.”

References

Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 2016; Advance online publication 6 May. DOI: http://dx.doi.org/10.1016/S1470-2045(16)00173-X

Petrella F, Spaggiari L. The smaller the better: a new concept in thoracic surgery? Lancet Oncol 2016; Advance online publication 6 May. DOI: http://dx.doi.org/10.1016/S1470-2045(16)30049-3

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