Propensity Score Analysis Comparing Videothoracoscopic Lobectomy With Thoracotomy: A French Nationwide Study

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• 作者：Pierre-Benoit Pag&egrave ; s ; MD ; PhD^a ; ^{pierrebenoit.pages@chu-dijon.fr" class="auth_mail" title="E-mail the corresponding author} ; Jean-Philippe Delpy ; MD^a ; Bastien Orsini ; MD^b ; Dominique Gossot ; MD^c ; Jean-Marc Baste ; MD ; PhD^d ; Pascal Thomas ; MD ; PhD^b ; Marcel Dahan ; MD ; PhD^e ; Alain Bernard ; MD ; PhD^a ; for the Epithor project (French Society of Thoracic ; Cardiovascular Surgery)
• 关键词：ASA ; American Society of Anesthesiologists ; CI ; confidence interval ; DFS ; disease-free survival ; FEV ; forced expiratory volume ; FSTCS ; French Society of Thoracic and Cardiovascular Surgery ; IPTW ; inverse probability of treatment weighting ; LOS ; length of stay ; NSCLC ; non-small cell lung cancer ; OS ; overall survival ; OT ; open thoracotomy ; PS ; propensity score ; RCT ; randomized controlled trial ; VATS ; video-assisted thoracoscopic surgery
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：101
• 期：4
• 页码：1370-1378
• 全文大小：943 K

文摘

Video-assisted thoracoscopic surgery (VATS) lobectomy has recently become the recommended approach for stage I non-small cell lung cancer. However, these guidelines are not based on any large randomized control trial. Our study used propensity scores and a sensitivity analysis to compare VATS lobectomy with open thoracotomy.

Methods

From 2005 to 2012, 24,811 patients (95.1%) were operated on by open thoracotomy and 1,278 (4.9%) by VATS. The end points were 30-day postoperative death, postoperative complications, hospital stay, overall survival, and disease-free survival. Two propensity scores analyses were performed: matching and inverse probability of treatment weighting, and one sensitivity analysis to unmask potential hidden bias. A subgroup analysis was performed to compare “high-risk” with “low-risk” patients. Results are reported by odds ratios or hazard ratios and their 95% confidence intervals.

Results

Postoperative death was not significantly reduced by VATS whatever the analysis. Concerning postoperative complications, VATS significantly decreased the occurrence of atelectasis and pneumopathy with both analysis methods, but there were no differences in the occurrence of other postoperative complications. VATS did not provide a benefit for high-risk patients. The VATS approach decreased the hospital length of stay from 2.4 days (95% confidence interval, –1.7 to –3 days) to –4.68 days (95% confidence interval, –8.5 to 0.9 days). Overall survival and disease-free survival were not influenced by the surgical approach. The sensitivity analysis showed potential biases.

Conclusions

The results must be interpreted carefully because of the differences observed according to the propensity scores method used. A multicenter randomized controlled trial is necessary to limit the biases.