Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to XXXX   .

@entity1 @entity358 @entity5 @entity2
OBJECTIVE: To compare the video-assisted thoracoscopic surgery (VATS) with the open thoracotomy access to @entity358 by the clinical outcomes and long-term survival in @entity2 . METHODS: Non-randomized comparative intention-to-treat study of prospective institutional registry data and survival data of 100 consecutive @entity1 undergoing segmentectomy. RESULTS: Within one decade (2002-12), 100 @entity1 with proven or highly suspected @entity2 underwent 100 anatomical sub-lobar pulmonary resections (52 typical and 20 atypical segmentectomies, 28 split-lobe procedures). Fifty-six @entity1 were operated by VATS and 44 by thoracotomy access. Comparison of demographic, medical, oncological and surgical baseline data did not provide evidence for differences between the VATS and thoracotomy groups. The surgery time for the VATS group was 225    62 min and 195    57 min for the thoracotomy group (P = 0.014). Postoperative hospitalization was 9 days for the VATS group and 12 days for the thoracotomy group (P = 0.034). Postoperative morbidity was 35.7% for the VATS group and 50% for the thoracotomy group (P = 0.161). Both groups had no 30-day mortality. Conversion to thoracotomy occurred in 30.4% of the VATS group. Conversion was more frequent in @entity1 with male gender, critical and prohibitive lung function, @entity5 with diameters exceeding 3 cm and atypical segmentectomies. The fractions of the pathological Union international contre le @entity5 (UICC) stages I, II and III were 74.4, 11.6 and 14% in the VATS group, and 70, 20 and 10% in the thoracotomy group (P = 0.445), respectively. Five-year overall survival was 86% in the VATS group and 69.9% in the thoracotomy group (P = 0.047), and 5-year recurrence-free survival was 58.5 and 48.6% (P = 0.480), respectively. CONCLUSIONS: Compared with thoracotomy access, the VATS approach to segmentectomy was associated with less postoperative morbidity and a 25% decrease in median hospital stay, despite a conversion rate of 30% due to the inclusion of atypical segmentectomies, higher @entity5 stages and @entity1 with critical function for single lung ventilation. Five-year survival estimates suggested a small but significant overall survival benefit and a 10% difference of recurrence-free survival in favour of VATS. Although not fully conclusive, long-term results indicate that the thoracoscopic access to segmentectomy is probably not inferior to the thoracotomy approach. Confirmation by a larger number of risk-adjusted outcome data is required.
