Perioperative Improvements for Changing the Non-small Cell Lung Cancer Surgical Approach

Background: Video-assisted thoracic surgery (VATS) procedures for non-small cell lung cancer (NSCLC) have steadily increased and become the gold standard, but the prognostic advantage compared to thoracotomy has not been elucidated. This study retrospectively evaluated perioperative characteristics of VATS for NSCLC over time.MethodsWe collected the clinical data of 760 patients with NSCLC who underwent pulmonary resection over the last decade, classifying patients into early (2011–2015) and late (2016–2020) periods. Changes in NSCLC patient characteristics, surgical approaches, perioperative factors, postoperative morbidities, and prognoses were analyzed.ResultsPatients in the late period were older (p = 0.01), had more comorbidities (p = 0.01), and had earlier-stage cancer (p < 0.01) than those in the early period. The late period had significantly fewer operative procedures for lobectomy or more (p < 0.01), open thoracotomies (p < 0.01), postoperative (p = 0.02) and severe morbidities (p < 0.01), and a significantly shorter postoperative hospital stay than the early period. Operative procedures of lobectomy or more (p < 0.01) were significant risk factors for postoperative morbidity, and being in the early period (p < 0.01) and operative procedures of lobectomy or more (p < 0.01) were significant risk factors for severe postoperative morbidities. The overall survival prognosis significantly differed between the groups (p = 0.02), but progression-free survival did not (p = 0.89).ConclusionThe incidence of postoperative morbidities decreased over time in older patients and patients with more comorbidities. The prognosis of patients with NSCLC did not change with increasing VATS or sublobar resection. Trial registration: The Institutional Review Board of Kanazawa Medical University approved the protocol of this retrospective study (approval number: I392), and written informed consent was obtained from all patients.