Individual patient data meta-analysis of randomized trials of survival with VATS compared with open lobectomy for lung cancer

Video-assisted thoracoscopic surgery (VATS) is the most common approach for pulmonary lobectomy in early-stage lung cancer, with as reported advantages less pain, fewer complication, faster recovery, and improved postoperative quality of life. The oncological safety of VATS compared with open surgery is not clear. An individual patient data (IPD) meta-analysis of randomized trials compared survival after VATS versus open lobectomy. After screening 554 articles, the authors identified three studies eilgible for inclusion. Data were provided for 1185 patients (586 randomzed to VATS and 599 to open lobectomy. Overall survival favored VATS lobectomy (HR 0.79; 95% CI 0.65-0.96). Disease-free survival was similar in both groups (HR 0.91; 95% CI 0.75-1.12). There was no evidence of statistical heterogeneity across trial for either outcome. The authors conclude that this meta-analysis provides evidence that surgical access by VATS lobectomy improved overall survival compared with open surgery without any compromise to disease-free survival.