Comparing Survival Outcomes and Secondary Outcomes of VATS versus Open Lobectomy for Early-Stage NSCLC: A Propensity Score Matched Analysis

Background: Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique for lobectomy in non-small-cell lung cancer (NSCLC), offering advantages such as reduced complications and quicker recovery compared to open lobectomy. However, the long-term survival benefits of VATS relative to open lobectomy remain unclear, particularly in observational studies where treatment selection may introduce bias. Objectives: This retrospective study compared overall survival and secondary outcomes (e.g., length of hospital stay and complications) between VATS and open lobectomy among patients with early-stage NSCLC treated at Princess Margaret Hospital between 2002 and 2010. The study also attempted to address the gap in knowledge regarding the effectiveness of VATS when baseline characteristics differ between surgical methods. Methods: Propensity score matching (PSM) was used to balance baseline covariates between the VATS and open lobectomy groups. Kaplan-Meier survival analysis and Cox proportional hazards models were applied to evaluate overall survival. Linear regression and logistic regression models were employed to analyze the length of hospital stay and the incidence of complications, respectively. Results: After matching, there were no significant differences in overall survival between VATS and open lobectomy. VATS was associated with significantly shorter hospital stays (p-value ≤0.001) and a lower likelihood of complications (OR = 0.62, p-value = 0.05). Conclusions: VATS and open lobectomy had comparable survival outcomes in patients with early-stage NSCLC after balancing baseline characteristics. VATS was associated with reduced hospital stay and complications, supporting its use as a viable alternative to open lobectomy in appropriate patients. These results suggest that VATS may offer clinical advantages, potentially influencing surgical decision-making in the management of NSCLC.